Claims Customer Service Advocate II - Request #37774150

Southcarolinablues; Columbia (SC); Vor Ort; USD 21.000 - 23.000; Vollzeit

Zusammenfassung

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II to handle inquiries, review and adjudicate claims and non-medical appeals, and make pay decisions following organizational policies and procedures. The role requires 2 years of customer service experience including claims or appeals processing OR a Bachelor's Degree in lieu of work experience.

Proficiency in Microsoft Office and strong communication skills are essential in a typical Columbia, SC office

Qualifikationen

• 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.

Aufgaben

• Respond to customer inquiries accurately, timely, and courteously by 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.

Kenntnisse

Verbal communication

Written communication

Customer service

Spelling/grammar

Basic math

Discretion

Ausbildung

High School Diploma or equivalent

Tools

Microsoft Office

Jobbeschreibung

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 Details:

• Contract

Position 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.

Essential Duties and Responsibilities

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

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.

Pay Transparency:

• This is the pay range that Magnit reasonably expects to pay someone for this position is $15.00/hour - $16.76/hour W-2.
• 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,