Claims Resolution Specialist II

Southcarolinablues; Myrtle Beach, Northern (SC, KY); Hybrid; USD 32,000 - 42,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II to respond to routine inquiries by phone and mail. You will identify incorrectly processed claims, perform adjustments, and reprocessing actions in accordance with department guidelines, ensuring timely and accurate results.

The role involves handling complex issues by escalating to leadership and contributing to projects within the claims department.

Qualifications

• Requires good verbal and written communication skills.
• Strong customer service skills and ability to handle confidential information with discretion.
• Attention to spelling, punctuation and grammar; basic business math.
• Bachelor's degree may substitute for work experience.
• Proficiency with Microsoft Office to complete claims processing tasks.

Responsibilities

• Respond to telephone inquiries following desk procedures to meet timeliness, productivity and quality standards.
• Research and respond to written inquiries; identify misprocessed claims and complete adjustments and reprocessing actions.
• Identify and refer complex complaints to a lead or manager; report potential fraud or abuse.
• Complete projects related to claims processing and customer service within the department.

Skills

Verbal communication

Written communication

Customer service

Spelling/grammar

Discretion with sensitive information

Education

High School Diploma or equivalent

Bachelor's degree in lieu of work experience

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II to respond to routine inquiries by phone and mail. You will identify incorrectly processed claims, perform adjustments, and reprocessing actions in accordance with department guidelines, ensuring timely and accurate results.

The role involves handling complex issues by escalating to leadership and contributing to projects within the claims department.