FCMB Customer Service Advocate II

001 BlueCross and BlueShield of South Carolina; Florence (SC); On-site; USD 35,000 - 50,000; Full time

Benefits offered by this job

Subsidized health plans

401(k) retirement savings plan with company match

Paid Time Off (PTO)

Education Assistance

National discounts to movies and theme parks

Job summary

001 BlueCross and BlueShield of South Carolina is looking for a responsive individual in Florence, SC to handle customer inquiries and claims processing. The role requires a high school diploma, with customer service and claims experience preferred.

Successful candidates will possess strong communication skills and be able to work in a typical office environment with flexible shifts. Benefits include health plans, 401(k), and paid time off.

Qualifications

• 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.
• Ability to handle confidential or sensitive information with discretion.

Responsibilities

• Research and respond to telephone inquiries according to desk procedures.
• Handle written inquiries and complete adjustment and/or reprocessing actions.
• Identify complaints and inquiries of a complexity level that cannot be resolved.

Skills

Good verbal and written communication skills

Strong customer service skills

Basic business math proficiency

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.

Position Purpose

From the moment of login, you will focus on proactively resolving members’ and/or providers’ questions and concerns using computer-based resources. You will communicate via telephone, written, web, or walk-in inquiries, guide members and providers with their healthcare needs by explaining benefits, solving claim concerns, and helping find a doctor through telephone calls, online chats, or e‑mail. When necessary, you will collaborate with other departments, conduct extensive research, and document all interactions accurately to ensure successful resolution. As the subject‑matter expert, you will offer recommendations, feedback, process improvements, and assistance with special projects. Once mastered, you will train and share knowledge with new team members.

What You’ll Do

• Research and respond to telephone inquiries according to desk procedures, ensuring contract standards and objectives for timeliness, productivity, and quality are met.
• Handle written inquiries, identify incorrectly processed claims, and complete the adjustment and/or reprocessing action per department guidelines, including initiating, documenting, and processing requests to completion.
• Initiate recoupments as necessary.
• Identify complaints and inquiries of a complexity level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution.
• Identify and report potential fraud and abuse situations.
• Complete projects and/or assignments related to claims processing and customer service functions in the department.

To Qualify for This Position

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.

Preferred Attributes

• Strong human relations and organizational skills, with a demonstrated ability to handle high‑stress and intense situations and conversations.
• Good judgment and the ability to handle confidential or sensitive information with discretion.
• Ability to learn.

Required Software and Other Tools

Microsoft Office.

Work Environment

Typical office environment. Employees are required to have flexibility to work any of the 8‑hour shifts scheduled during normal business hours. Occasional overtime and weekend work may be required based on business needs. The role is located at 200 North Dozier Boulevard, Florence, SC 29501, United States.

Our Comprehensive Benefits Package Includes The Following

• Subsidized health plans, dental and vision coverage.
• 401(k) retirement savings plan with company match.
• Life Insurance.
• Paid Time Off (PTO).
• On‑site cafeterias and fitness centers in major locations.
• Education Assistance.
• Service Recognition.
• National discounts to movies, theaters, zoos, theme parks, and more.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and its subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, 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 opportunities for individuals with disabilities and protected veterans. We are committed to providing reasonable accommodations for individuals with disabilities and other protected statuses, provided that such accommodations do not impose undue hardship on the company. The company participates in E‑Verify and complies with the Pay Transparency Nondiscrimination Provision and is an Equal Opportunity Employer.