FCMB Customer Service Advocate II

BlueCross and BlueShield of South Carolina; Florence (SC); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

Health benefits

401k retirement plan with companymatch

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Job summary

BlueCross BlueShield of South Carolina in Florence, SC is seeking a full-time Member Services Representative. You will respond to routine inquiries about claims and appeals, guide members and providers, and use computer-based resources to resolve questions.

The role requires strong communication, accuracy, and discretion. Training is provided, with opportunities to contribute to process improvements and respond to complex situations as needed.

Qualifications

• High School Diploma or equivalent required.
• 2 years customer service experience OR 1 year claims/appeals processing plus 1 year customer service.
• Strong verbal and written communication and professional discretion.
• Proficiency in basic business math.
• Proficiency with Microsoft Office.

Responsibilities

• Research and respond to telephone inquiries, meeting desk procedures and quality targets.
• Identify incorrectly processed claims and complete adjustments and reprocessing actions.
• Escalate complex inquiries to a lead or manager and report potential fraud or abuse.
• Complete projects related to claims processing and customer service functions.

Skills

Verbal communication

Written communication

Customer service

Spelling/grammar

Basic math

Education

High School Diploma

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

Job Description

Position Purpose:

From the moment of login, you'll be focused on proactively resolving our members' and/or providers' questions and concerns using computer-based resources to find answers. Communication via telephone, written, web, or walk-in inquiries. You will guide members and providers with their healthcare needs by explaining benefits, solving claim concerns, and helping find a doctor via telephone calls, online chats, or e-mails. At times extensive research may be needed and it may be necessary to collaborate with other departments to find the answers needed. Accurately documenting these questions is vital for the success of this role. You are the subject matter expert for this role. Your leadership team is open to your recommendations, feedback, process improvements, and assistance with special projects to make positive changes for the department. Once you have mastered this role, training and sharing your knowledge with new team members can be a rewarding part of this role.

Logistics: PGBA

Location:

This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have the flexibility to work any of our 8-hour shift scheduled during our normal business hours. It may be necessary, given the business need to work occasional overtime and weekends. This role is located at 200 North Dozier Boulevard Florence, SC 29501 United States of America.

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.

To Qualify for This Position, You'll Need the Following:

• 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 Other Tools: Microsoft Office.
• Work Environment: Typical office environment.

We Prefer That You Have The Following:

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

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
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

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 the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies mainta