Claims & Appeals Specialist II | Customer Service Advocate

Southcarolinablues; Columbia (SC); Sur place; USD 21 000 - 23 000; Plein temps

Résumé du poste

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II to handle inquiries, review and adjudicate claims and non-medical appeals, and make pay decisions following organizational policies and procedures. The role requires 2 years of customer service experience including claims or appeals processing OR a Bachelor's Degree in lieu of work experience.

Proficiency in Microsoft Office and strong communication skills are essential in a typical Columbia, SC office

Qualifications

• Good verbal and written communication skills.
• Strong customer service skills.
• Good spelling, punctuation and grammar skills.
• Basic business math proficiency.
• Ability to handle confidential or sensitive information with discretion.

Responsabilités

• Respond to customer inquiries accurately, timely, and courteously by telephone, written, web, or walk-in inquiries.
• Handles situations which may require adaptation of response or extensive research.
• Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
• Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Ensures claims are processing according to established quality and production standards.
• Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution.
• Identifies and reports potential fraud and abuse situations.

Connaissances

Verbal communication

Written communication

Customer service

Spelling/grammar

Basic math

Discretion

Formation

High School Diploma or equivalent

Outils

Microsoft Office

Description du poste

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II to handle inquiries, review and adjudicate claims and non-medical appeals, and make pay decisions following organizational policies and procedures. The role requires 2 years of customer service experience including claims or appeals processing OR a Bachelor's Degree in lieu of work experience.

Proficiency in Microsoft Office and strong communication skills are essential in a typical Columbia, SC office