Claims Customer Service Advocate II

Southcarolinablues; Columbia (SC); Hybride; USD 42 000 - 56 000; Plein temps

Avantages offerts par ce poste

On-site cafeterias

Fitness centers

401k with company match

PTO

Education Assistance

Résumé du poste

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II to respond to inquiries and adjudicate claims in Columbia, SC. The role requires accuracy, discretion, and strong communication to support members and providers.

The position is full-time, on-site at 4101 Percival Road with possible overtime and weekends. Training is 8:00am–4:30pm, 40 hours/week, and benefits are included from the first month after 28 days of employment.

Qualifications

• High School Diploma or equivalent required.
• 2 years of customer service experience including 1 year claims or appeals processing, or a Bachelor's degree in lieu of experience.
• Strong verbal and written communication; ability to handle confidential information.

Responsabilités

• Respond to customer inquiries via phone, email, web, or walk-ins with accuracy and courtesy.
• Identify and process adjusted or reprocessed claims according to guidelines.
• Examine claims/appeals per regulations and enter data into the system with correct coding.

Connaissances

Customer service

Communication

Research

MS Office

Formation

High School Diploma or equivalent

Bachelor's Degree (in lieu of work experience)

Outils

Microsoft Office

Description du poste

## Claims Customer Service Advocate IIApply: On-site: Columbia, South Carolina: Full time: Posted Today: End Date: October 23, 2026 (13 days left to apply): R1052697# **Summary**Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.# **Description****Job Description****Location:**This position is full-time (40 hours/week) Monday - Friday in a typical office environment. Employees are required to work a training schedule of 8:00am to 4:30 pm. You will need to be available to work a 8-hour shift from of 8:00 am to 4:30 pm. It may be necessary, given the business need to work occasional overtime and weekends. This role is located at 4101 Percival Road, Columbia SC. **What You'll Do:*** Ensures effective customer relations by responding accurately, timely, and courteously to 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. **Sponsorship:** This position is not eligible for sponsorship now or in the future. **To Qualify for This Position, You'll Need:*** **Required Education:** High School Diploma or equivalent* **Required Work Experience:** 2 years of customer service experience including 1-year claims or appeals processing OR Bachelor's Degree in lieu of work experience.* **Required Skills and Abilities:** 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.* **Required Software and Other Tools:** Microsoft Office.* **Work Environment:** Typical office environment. **Our Comprehensive Benefits Package Includes the Following:**We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.* Subsidized health plans, dental and vision coverage* 401k retirement savings plan with company match* Life Insurance · Paid Time Off (PTO)* On-site cafeterias and fitness centers in major locations* Education Assistance* Service Recognition · National discounts to movies, theaters, zoos, theme parks and more **What We Can Do for You:**We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. ' **What To Expect Next:**After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.**Equal Employment Opportunity Statement** BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.