On-Site Claims Advocate II

Southcarolinablues; Columbia, Northern (SC, KY); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401K matching

Life Insurance

Paid Time Off

On-site cafeterias

Wellness program

Tuition assistance

Employee recognition

Employee assistance

Job summary

BlueCross BlueShield of South Carolina is seeking a FCMB Claims Customer Service Advocate II to work on-site in Columbia, SC. The role handles routine claims inquiries, processes adjustments, and ensures timeliness and quality in line with contract standards.

You’ll document inquiries, identify processing errors, and escalate complex cases to supervisors while maintaining confidentiality and providing strong customer service. The position requires eligibility for security clearance as a U.S.

Qualifications

• High school diploma or equivalent required.
• 1 year claims/appeals processing or related experience, or a bachelor's degree in lieu of experience.
• Strong communication and customer service skills.

Responsibilities

• Responds to written and telephone inquiries per desk procedures to meet timeliness and quality goals.
• Identifies incorrectly processed claims and processes adjustments and reprocessing actions.
• Enters claims into the system after verifying procedures and diagnosis codes.
• Recognizes complex issues and refers them to a lead or manager for resolution.
• Reports suspected fraud or system errors to the appropriate departments.

Skills

Verbal and Written Communication

Customer Service Skills

Spelling and Grammar

Basic Business Math

Confidential Information Handling

Education

High School Diploma or Equivalent

Associate degree (preferred)

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a FCMB Claims Customer Service Advocate II to work on-site in Columbia, SC. The role handles routine claims inquiries, processes adjustments, and ensures timeliness and quality in line with contract standards.

You’ll document inquiries, identify processing errors, and escalate complex cases to supervisors while maintaining confidentiality and providing strong customer service. The position requires eligibility for security clearance as a U.S.