Claims & Appeals Advocate II

Pgba, Llc; Columbia (SC); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Health insurance

401K with company match

Paid Time Off

On-site cafeterias & fitness centers

Tuition assistance

Employee assistance

Discounts to movies, theaters and more

Job summary

PGBA, a subsidiary of BlueCross BlueShield of South Carolina, seeks a Claims Customer Service Advocate II for on-site work in Columbia, SC. The role handles routine inquiries, documents interactions, and processes claims adjustments within contract guidelines. Training lasts 6–8 weeks with a standard 9AM–6PM schedule.

Eligibility requires U.S. citizenship for security clearance and the ability to obtain it. The team supports health benefits for federal contracts and non-sponsor status is noted.

Qualifications

• High School Diploma or equivalent required.
• 1 year of claims/appeals processing or related experience; or a bachelor’s degree.
• Strong verbal and written communication skills; customer service oriented.
• Ability to handle confidential information with discretion.

Responsibilities

• Respond to written and telephone inquiries per procedures.
• Document inquiries accurately and process adjustments/reprocessing.
• Enter claims into system after verifying codes.
• Identify complex issues and refer to lead/manager.
• Flag suspected fraud or system errors for investigation.

Skills

Communication Skills

Customer Service

Spelling & Grammar

Business Math

Confidential Information Handling

Education

High School Diploma or equivalent

Associate degree (preferred)

Tools

Microsoft Office

Word Processing

Spreadsheets

Database Software

Job description

PGBA, a subsidiary of BlueCross BlueShield of South Carolina, seeks a Claims Customer Service Advocate II for on-site work in Columbia, SC. The role handles routine inquiries, documents interactions, and processes claims adjustments within contract guidelines. Training lasts 6–8 weeks with a standard 9AM–6PM schedule.

Eligibility requires U.S. citizenship for security clearance and the ability to obtain it. The team supports health benefits for federal contracts and non-sponsor status is noted.