Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina; Columbia (SC); On-site; USD 35,000 - 45,000; Full time

Job summary

Join a leading insurance provider as a Claims Customer Service Advocate II. You'll handle customer inquiries, process claims, and ensure compliance with organizational policies. Be part of a dynamic team focused on community and innovation.

Benefits

Health coverage

Dental coverage

Vision coverage

401(k) with company match

Paid Time Off

Life insurance

Wellness programs

Tuition assistance

Qualifications

• 2+ years customer service experience including claims/appeals processing.

Responsibilities

• Respond to customer inquiries via phone, web, or walk-in.
• Examine and process claims and appeals accurately.
• Identify complex issues and report potential fraud.

Skills

Communication

Customer Service

Education

High School Diploma

Bachelor's Degree

Tools

Microsoft Office

Job description

Join to apply for the Claims Customer Service Advocate II role at BlueCross BlueShield of South Carolina

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Join to apply for the Claims Customer Service Advocate II role at BlueCross BlueShield of South Carolina

Summary
In this role as the Claims Customer Service Advocate II, you will respond to routine inquiries, which may sometimes be non-routine and require deviation from standard scripts and procedures. You will perform research to resolve inquiries, review and adjudicate claims and non-medical appeals, and determine whether to return, deny, or pay claims in accordance with organizational policies.

Why join us?
We are a longstanding, leading insurance provider in South Carolina with a rich history and diverse operations. We deliver excellent service and foster a community-oriented, innovative workplace. Join us to be part of a dynamic team with community roots and a future-focused approach.

Position Details
Location: On-site at 4101 Percival Road, Columbia, SC
Schedule: Full-time, Monday-Friday, 8:00 AM – 6:00 PM shifts, with training during 8:00 AM - 4:30 PM for 6-8 weeks.

Key Responsibilities

1. Respond effectively and courteously to customer inquiries via phone, web, or walk-in, and perform necessary research or adjustments.
2. Examine and process claims and appeals following regulations and standards, verifying coding and processing claims accurately.
3. Identify complex issues, escalate when necessary, and report potential fraud or abuse.

Qualifications

• High School Diploma or equivalent; 2+ years customer service experience including claims/appeals processing, or a Bachelor's Degree.
• Strong communication, customer service skills, and proficiency with Microsoft Office.
• Ability to handle sensitive information discreetly.

Benefits

• Health, dental, and vision coverage
• 401(k) with company match
• Paid Time Off, life insurance, wellness programs, tuition assistance, and more.

Application Process

After applying, your resume will be reviewed, and you may be contacted for an interview or further communication. We value diversity and are committed to equal employment opportunity and reasonable accommodations for applicants with disabilities.