Claims Customer Service Advocate II (Charleston, SC)

Unclassified - Charleston, SC

Full-time - Entry Level

Charleston, SC

About the position

Join our customer service team at BlueCross BlueShield of South Carolina, where you will assist federal employees and retirees in understanding their benefits coverage and claims processing. This role involves direct interaction with members, ensuring effective communication and support while processing claims and following up on inquiries.

Responsibilities

• Respond accurately, timely, and courteously to customer inquiries via telephone, written communication, web, or in-person.
• Handle complex situations requiring adaptation of responses or extensive research.
• Identify incorrectly processed claims and process adjustments according to department guidelines.
• Examine and process claims and non-medical appeals according to business regulations and internal standards.
• Enter claims into the system after verifying correct coding of procedures and diagnosis codes.
• Ensure claims are processed according to established quality and production standards.
• Identify and refer complex complaints and inquiries to a lead or manager for resolution.
• Report potential fraud and abuse situations.

Requirements

• Two years of customer service experience including one year in claims or appeals processing OR a Bachelor's Degree in lieu of work experience.
• High School Diploma or equivalent.
• Good verbal and written communication skills.
• Good spelling, punctuation, and grammar skills.

Nice-to-haves

• Prior healthcare office or insurance experience.

Benefits

• 401(k) retirement savings plan with company match
• Fantastic health plans and free vision coverage
• Life insurance
• Paid annual leave
• Nine paid holidays
• On-site cafeterias and fitness centers
• Wellness programs and healthy lifestyle premium discount
• Tuition assistance
• Service recognition