Claims Customer Service Advocate II

PGBA,; Myrtle Beach (SC); On-site; USD 38,000 - 46,000; Full time

Benefits offered by this job

Subsidized health plans

401K retirement savings plan with 회사 매

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Wellness program

Tuition assistance

Employee Assistance

Job summary

BlueCross BlueShield of South Carolina seeks a claims/appeals professional for on-site work in Myrtle Beach. responsibilities include responding to inquiries, processing claims and adjustments, and ensuring timeliness and quality per contract standards.

The role requires a high school diploma, 1 year of claims/appeals processing (or a bachelor's degree in lieu), and strong communication and discretion. Comprehensive benefits apply after 28 days, with training in a typical office schedule.

Qualifications

• High school diploma or equivalent required.
• 1 year claims/appeals processing or related experience, or a bachelor's degree in lieu of experience.
• Strong verbal and written communication skills.
• Excellent customer service and accuracy.
• Ability to handle confidential information with discretion.

Responsibilities

• Respond to written and telephone inquiries and document interactions.
• Process claims and appeals; perform adjustments and reprocessing per guidelines.
• Identify complex issues and route for escalation when needed.

Skills

Verbal and written communication

Customer service

Spelling and grammar

Business math

Discretion with confidential info

Microsoft Office

Education

High school diploma or equivalent

1 year claims/appeals processing or related experience, or bachelor's degree in lieu of experience

Tools

Microsoft Office

Job description

Summary

Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

Logistics

PGBA – is a subsidiary company of BlueCross BlueShield of South Carolina.

Location

This position is Full Time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility work any of our 8-hour shift scheduled during hours of 9am to 6pm due to contractual obligations. Training will be Monday – Friday 8:00 AM 5:00 PM for approximately 6-8 weeks. This role is located on site at 8733 Highway 17 Bypass, Mrytle Beach SC.

• Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

• SCA Benefit Requirements : BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O’Hara Service Contract Act (SCA), employees are required to enroll in health insurance benefits regardless of other insurance coverage. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

Sponsorship

This position is not eligible for sponsorship now or in the future.

What You’ll Do

• Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. 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 promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

To Qualify for This Position, You’ll Need the Following

• Required Education:
• A High School Diploma or equivalent
• Required Work Experience:
• 1-year of experience including 1-year claims/appeals processing, customer service, or other related support area 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 Manage Confidential or Sensitive Information with Discretion.
• Required Software and Tools:
• Microsoft Office.

What We Prefer that you Have the Following

• Associate degree
• (2) years-of claims processing or call center experience.
• Knowledge of word processing, spreadsheet, and database software.

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] 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 moreinformation.

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