FCMB Claims Customer Service 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

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

• 60% Researches and responds to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
• 20% 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.
• 10% 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.
• 10% Completes projects and/or assignments related to claims processing and customer service functions in the department.

Required Work Experience

• Two years of customer service experience OR one year of claims or appeals processing experience and one year of customer service experience OR Bachelor's Degree in lieu of work experience.

Required Education

High School Diploma or equivalent.

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 Other Tools

• Microsoft Office.

Work Environment

Typical office environment.

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 disabilities and 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] or 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 more information.

Some states have required notifications. Here's more information.