FCMB Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina; Columbia (SC); On-site; USD 35,000 - 55,000; Full time

Job summary

An established industry player is seeking a dedicated Claims Processing Specialist to join their team. This full-time role involves responding to inquiries, processing claims, and ensuring high-quality customer service standards are met. The ideal candidate will possess strong communication skills and a knack for problem-solving. You'll thrive in a supportive environment that values diversity and offers comprehensive benefits, including health plans, retirement savings, and tuition assistance. If you’re passionate about making a difference in the healthcare sector, this opportunity is for you!

Benefits

401(k) retirement savings plan with company match

Health plans and free vision coverage

Life insurance

Paid annual leave

Nine paid holidays

On-site cafeterias

Fitness centers in major locations

Wellness programs

Tuition assistance

Service recognition

Qualifications

• Good verbal and written communication skills.
• Strong customer service skills and basic business math proficiency.

Responsibilities

• Respond to telephone inquiries and process claims adjustments.
• Identify and report potential fraud and abuse situations.

Skills

Verbal Communication

Written Communication

Customer Service

Business Math

Microsoft Office

Education

High School Diploma or equivalent

Bachelor's Degree

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

Logistics:This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to work a 10:00am to 7:00pm. It may be necessary, given the business need to work occasional overtime. This position is located at 17 Technology Circle, Columbia, SC.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.
• 1Completes projects and/or assignments related to claims processing and customer service functions in the department.

To Qualify for This Position, You'll Need:

• High School Diploma or equivalent
• 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
• Microsoft Office.

What we prefer you have:

• 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.

Work Environment:

• Typical office environment.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match

• Fantastic health plans and free vision coverage

• Life insurance

• Paid annual leave - the longer you work here, the more you earn

• Nine paid holidays

• On-site cafeterias and fitness centers in major locations

• Wellness programs and a healthy lifestyle premium discount

• Tuition assistance

• Service recognition

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. Management will be conducting interviews with the most qualified candidate.

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 origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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