On-Site Claims Support Advocate I

Southcarolinablues; Columbia, Northern (SC, KY); Hybrid; USD 36,000 - 52,000; Full time

Benefits offered by this job

Health benefits

401K retirement plan

Paid time off

On-site cafeterias

Job summary

PGBA, a subsidiary of BlueCross BlueShield of South Carolina, hires for an on-site Claims Customer Service Advocate I in Columbia, SC. The role supports timely and accurate responses to inquiries and processes claim adjustments.

Qualified candidates will have a High School Diploma or equivalent, or a Bachelor's degree in lieu of experience, plus 1 year of related experience. Proficiency in Microsoft Office is required.

Qualifications

• High School Diploma or equivalent required; bachelor’s degree may substitute for experience.
• 1 year of experience in claims/appeals processing, customer service, or related support area.
• Strong written and verbal communication; ability to handle confidential information.

Responsibilities

• Responds to written and/or telephone inquiries according to desk procedures, documenting inquiries accurately.
• Identifies incorrectly processed claims and processes adjustments and reprocessing actions.
• Examines and adjudicates claims and/or non-medical appeals according to regulations and guidelines.
• Enters claims into the system with verification of correct coding; escalates complex issues as needed.

Skills

Verbal communication

Written communication

Customer service

Confidentiality

Basic math

Education

High School Diploma or equivalent

Bachelor's degree in lieu of experience

Tools

Microsoft Office

Job description

PGBA, a subsidiary of BlueCross BlueShield of South Carolina, hires for an on-site Claims Customer Service Advocate I in Columbia, SC. The role supports timely and accurate responses to inquiries and processes claim adjustments.

Qualified candidates will have a High School Diploma or equivalent, or a Bachelor's degree in lieu of experience, plus 1 year of related experience. Proficiency in Microsoft Office is required.