Claims Customer Service Advocate II - Request #35879690

WillHire; Columbia (SC); On-site; USD 10,000 - 60,000; Full time

Job summary

Join a renowned health insurance company that has been a pillar in the South Carolina community for over seven decades. As a Claims Customer Service Advocate II, you will play a crucial role in ensuring customer satisfaction by addressing inquiries and adjudicating claims. This position offers a structured work environment with a focus on quality and service excellence. You will be part of a diverse team committed to delivering outstanding service while enjoying comprehensive benefits, including medical, dental, and 401K options. If you have a passion for customer service and a strong desire to contribute to a community-focused organization, this is the opportunity for you.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401K

Qualifications

• 2 years of customer service experience including 1 year in claims or appeals processing.
• Strong verbal and written communication skills are required.

Responsibilities

• Respond to customer inquiries and perform research to resolve issues.
• Examine and process claims according to regulations and guidelines.

Skills

Medical background

Customer service

Office experience

Call center experience

Basic business math proficiency

Education

High School Diploma or equivalent

Bachelor's Degree

Tools

Microsoft Office

Job description

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’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re 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 dedicated to the same philosophy, consider joining our team!

Job Title:Claims Customer Service Advocate II

Position Notes:

• Mon-Fri, 8 AM -4:30 PM.
• Contract to Hire.
• 6 weeks, no option for remote work·.
  

Responsibilities:

• 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.
• 45% 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.
• 45% 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.
• 10% 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.

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.

Required Education: High School Diploma or equivalent

Skills: Medical background, office experience, customer service, previous call center experience

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.

This is the pay range that Magnit reasonably expects to pay someone for this position is$16.00/hour - $16.00/hour. Benefits:Medical, Dental, Vision, 401K (provided minimum eligibility hours are met).

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson.If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!