Customer Service Advocate II

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 21,000 - 30,000; Full time

Benefits offered by this job

Subsidized health plans

401K with company match

Life Insurance

Paid Time Off

Job summary

BlueCross BlueShield of South Carolina is seeking a dedicated customer service professional to provide prompt, accurate responses to inquiries. The role involves researching and resolving non-routine questions, documenting interactions, and ensuring adherence to contract standards.

The position is full-time, primarily on-site in Columbia, with occasional overtime and potential inter-building travel. Training will be conducted on-site for several weeks.

Qualifications

• A High School Diploma or equivalent is required.
• 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.
• Excellent verbal and written communication, strong customer service, and good spelling and grammar.
• Basic business math proficiency and ability to manage confidential or sensitive information with discretion.

Responsibilities

• Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
• Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
• Identifies complex inquiries and refers to a lead or manager for resolution.

Skills

Verbal communication

Written communication

Customer service

Spelling and grammar

Business math

Discretion with confidential info

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.

Description

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose :

Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.

Location:

This position is full-time (40 hours/week) Monday through Friday in a typical office environment. You will work an 8-hour sift scheduled during our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located on-site at 4101 Percival Road; Columbia SC. Training will be onsite Monday-Friday 8:00 AM -5 PM for approximately 8-10 weeks.

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:

• 6 months BlueVue Experience
• 6 months Population Health Experience
• 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 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.

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