Claims Customer Advocate II: Resolution & Service

Southcarolinablues; Columbia, Northern (SC, KY); Hybrid; USD 35,000 - 52,000; Full time

Benefits offered by this job

Subsidized health plans

401K retirement plan with companymatch

Life Insurance

Paid Time Off (PTO)

On-site cafeterias

Wellness program

Tuition assistance

Employee Assistance

Job summary

BlueCross BlueShield of South Carolina seeks a Claims Customer Service Advocate II to respond to inquiries, adjudicate claims, and process non-medical appeals. This on-site role in Columbia requires accuracy, discretion, and strong communication.

Qualifications include 2 years of customer service with 1 year claims experience or a Bachelor's degree in lieu of experience, plus proficiency with Microsoft Office. Training will occur during first weeks; sponsorship is not offered.

Qualifications

• High School diploma or equivalent required.
• 2 years of customer service with 1 year claims/appeals processing OR a bachelor's degree in lieu of experience.
• Strong written and verbal communication, ability to handle confidential information.

Responsibilities

• Respond to customer inquiries by phone, email, web, or walk-in with accuracy and courtesy.
• Identify complex issues and refer to lead/manager for resolution when needed.
• Examine and process claims or non-medical appeals per regulations and guidelines.
• Enter claims into the system with correct coding after verification.
• Detect potential fraud/abuse and report per policy.
• Adhere to quality and production standards during processing.

Skills

Customer service

Communication

Attention to detail

Discretion

Teamwork

Education

High School Diploma or equivalent

Bachelor's degree (optional in lieu of experience)

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina seeks a Claims Customer Service Advocate II to respond to inquiries, adjudicate claims, and process non-medical appeals. This on-site role in Columbia requires accuracy, discretion, and strong communication.

Qualifications include 2 years of customer service with 1 year claims experience or a Bachelor's degree in lieu of experience, plus proficiency with Microsoft Office. Training will occur during first weeks; sponsorship is not offered.