Claims Resolution Advocate II

ourhrconnect; Myrtle Beach (SC); On-site; USD 32,000 - 42,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking a claims/appeals associate to handle routine inquiries by phone and correspondence. You will identify incorrectly processed claims, perform adjustments, and reprocess actions in line with department guidelines.

The role requires strong communication and customer service skills, ability to work with confidential information, and proficient use of Microsoft Office.

Qualifications

• 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.

Responsibilities

• Respond to routine correspondence and telephone inquiries pertaining to claims or appeals.
• Identify incorrectly processed claims and complete adjustments and reprocessing actions.
• Research and respond to written inquiries and initiate recoupments as necessary.
• Identify and refer complex complaints to a lead or manager for resolution; report potential fraud and abuse.
• Complete projects and assignments related to claims processing and customer service.

Skills

Verbal communication

Written communication

Customer service

Spelling and grammar

Confidential information handling

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a claims/appeals associate to handle routine inquiries by phone and correspondence. You will identify incorrectly processed claims, perform adjustments, and reprocess actions in line with department guidelines.

The role requires strong communication and customer service skills, ability to work with confidential information, and proficient use of Microsoft Office.