On-Site Claims Advocate: Complex Inquiries & Appeals

Southcarolinablues; Columbia (SC); On-site; USD 42,000 - 66,000; Full time

Benefits offered by this job

Subsidized health plans

Dental coverage

Vision coverage

401k with company match

Life Insurance

PTO

Job summary

BlueCross BlueShield of South Carolina is hiring a Claims Customer Service Advocate III to provide prompt and accurate responses to complex inquiries. The role requires researching issues, adjudicating complex claims or non-medical appeals, and ensuring adherence to contracts and internal standards.

On-site in Columbia, SC, with training and standard 9- to 6-hour shifts. The position supports process improvements, training of representatives, and collaboration with management to meet quality and

Qualifications

• 3 years of customer service experience with claims/appeals preferred or a Bachelor's degree in lieu of experience.
• High school diploma or equivalent required.
• Strong written and verbal communication; ability to handle confidential information.

Responsibilities

• Review claims and appeals to determine adherence to procedures.
• Research complex inquiries and research root causes.
• Adjudicate complex or specialty claims and non-medical appeals.
• Enter claims with correct coding and ensure quality/production standards.
• Provide feedback to management and assist training of staff.

Skills

Verbal communication

Written communication

Customer service

Discretion

Basic math

Education

High School Diploma

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring a Claims Customer Service Advocate III to provide prompt and accurate responses to complex inquiries. The role requires researching issues, adjudicating complex claims or non-medical appeals, and ensuring adherence to contracts and internal standards.

On-site in Columbia, SC, with training and standard 9- to 6-hour shifts. The position supports process improvements, training of representatives, and collaboration with management to meet quality and