Senior Claims & Appeals Advocate - Onsite in Columbia

Pgba, Llc; Columbia (SC); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings with company m

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Job summary

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate III in Columbia. You will provide prompt, accurate responses to complex inquiries, review and adjudicate claims and non-medical appeals, and research issues to determine appropriate outcomes based on policy requirements.

This on-site role requires 3 years of customer service with claims/appeals processing or a Bachelor's degree in lieu of experience, plus a High School Diploma.

Qualifications

• 3 years of customer service experience, including 1 year of claims or appeals processing, or a Bachelor's degree in lieu of experience.
• High School Diploma required.
• Strong verbal and written communication; ability to handle confidential information with discretion.

Responsibilities

• Review claims or appeals and determine if procedures were followed.
• Research underlying causes and recommend corrective actions.
• Identify potential fraud/abuse and report it.
• Enter claims into the system with proper coding and accuracy.
• Ensure processing meets quality and production standards.
• Provide feedback to management and assist with process improvements.
• Assist in training customer service representatives.

Skills

Communication skills

Customer service

Confidentiality

Business math

Microsoft Office

Education

High School Diploma

Bachelor's Degree (in lieu of experience)

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate III in Columbia. You will provide prompt, accurate responses to complex inquiries, review and adjudicate claims and non-medical appeals, and research issues to determine appropriate outcomes based on policy requirements.

This on-site role requires 3 years of customer service with claims/appeals processing or a Bachelor's degree in lieu of experience, plus a High School Diploma.