FCMB Claims Customer Service Advocate II

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Subsidized health plans

401K retirement savings plan with公司|匹配

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Wellness program and healthy lifestyle

Tuition assistance

Service recognition

Employee Assistance

Discounts to movies

Job summary

BlueCross BlueShield of South Carolina is seeking a full-time Claims Support role in Columbia. The position handles routine correspondence and telephone inquiries about claims or appeals, and identifies and reprocesses incorrectly processed claims.

The role is on-site at 17 Technology Circle, Columbia, with typical 8-hour shifts from 8:00 AM to 6:00 PM, Monday through Friday, and occasional overtime. US citizenship required for security clearance.

Qualifications

• High School Diploma or equivalent.
• 2 years of customer service experience OR 1 year of claims or appeals processing experience and 1 year of customer service experience OR Bachelor's Degree in lieu of work experience.
• Good verbal and written communication, strong customer service, and good spelling, punctuation and grammar.
• Basic business math proficiency.
• Ability to handle confidential or sensitive information with discretion.
• Microsoft Office proficiency.

Responsibilities

• Researches and responds to telephone inquiries according to desk procedures, ensuring timeliness, productivity, and quality.
• Research and respond to written inquiries and identify incorrectly processed claims and completes the adjustment and/or reprocessing action.
• Identifies complex inquiries and refers to a lead or manager; identifies potential fraud and abuse.
• Completes projects and/or assignments related to claims processing and customer service functions.

Skills

Communication

Customer service

Discretion

Math basics

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

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

Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

Logistics

PGBA - one of BlueCross BlueShield's South Carolina subsidiary companies.

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 - 6:00 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 17 Technology Circle, Columbia. Training will be onsite Monday-Friday 8:00 AM -5 PM for approximately 8-10 weeks.

Government Clearance

This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

SCA Benefit Requirements

BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act ( SCA ) . As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

Sponsorship

This position is not eligible for sponsorship now or in the future.

What You'll Do

• Researches and responds to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
• Research and respond to written inquiries and identify incorrectly processed claims and completes the adjustment and/or reprocessing action according to department guidelines. This may include initiating, documenting, and processing the request to completion. Initiate recoupments as necessary.
• Identifies complaints and inquiries of a complexity 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.
• Completes projects and/or assignments related to claims processing and customer service functions in the department.

Required Education

• High School Diploma or equivalent

Required Work Experience

• 2 years of customer service experience OR 1 year of claims or appeals processing experience and 1 year of customer service experience 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 handle confidential or sensitive information with discretion.

Required Software and Tools

• Microsoft Office.

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.