Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina; Columbia (SC); On-site; USD 40,000 - 55,000; Full time

Job summary

Join a leading insurance company as a Claims Customer Service Advocate II, where you'll handle inquiries, process claims, and ensure excellent customer service. This full-time role offers a dynamic work environment with a focus on community roots and innovation. Enjoy a comprehensive benefits package and opportunities for career advancement.

Benefits

Life Insurance

Paid Time Off

Tuition Assistance

401(k)

Subsidized Health Plans

Dental Coverage

Vision Coverage

Wellness Program

Employee Assistance

Discounts to Entertainment

Qualifications

• 2 years customer service experience or Bachelor's Degree.
• Good verbal and written communication skills.

Responsibilities

• Respond to customer inquiries accurately and courteously.
• Examine and process claims according to regulations.
• Identify and report potential fraud situations.

Skills

Communication

Customer Service

Business Math

Education

High School Diploma

Bachelor's Degree

Tools

Microsoft Office

Job description

life insurance, paid time off, tuition assistance, 401(k)

United States, South Carolina, Columbia

May 12, 2025

Summary In the role as the Claims Customer Service Advocate II, the ideal candidate will be responsible for responding to routine inquiries. These inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. The Claims Customer Service Advocate II will perform research as needed to resolve inquiries. The ideal candidate will review and adjudicate claims and/or non-medical appeals as well as determine whether to return, deny, or pay claims following organizational policies and procedures.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future. Description

Location:

This position is full time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility to work any of our 8-hour scheduled shifts during the hours of 8:00 AM -6:00 PM. Training will be Monday - Friday 8:00 AM - 4:30 PM for approximately 6-8 weeks. This role is located on site 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.

To Qualify for This Position, You'll Need the Following:

• Required Education :
• High School Diploma or equivalent
• Required Work Experience:
• 2 years of customer service experience including 1 year of claims or appeals processing experience 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 p roficiency.
• Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools:
• Microsoft office

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
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Employee Assistance
• 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.

Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the required qualifications.

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 disabilitiesand 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] 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 moreinformation.

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