• Job Description

  Req#: R1026527

  
  Summary
  

  We are hiring a Claims Customer Service Advocate I. In this role, you will be responsible for responding to routine inquiries. Identify incorrectly processed claims and completes adjustments and related reprocessing actions. Review and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.

  
  Description
  

  Logistics

  This position is part-time opportunity. This role is onsite Myrtle Beach, SC.

  What You’ll Do
  

  • Respond to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
  • Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensure claims are processing according to established quality and production standards.
  • Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identify and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

  To Qualify for this Position, You’ll Need

  • High School Diploma or equivalent
  • 1 year of experience in a claims/appeals processing, customer service, or other related support area OR Bachelor's Degree in lieu of work experience.
  • 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.
  • Microsoft Office.

  What We Can Do for You

  You are not alone. We are here to support you:

  Six weeks of training including:

  • Best-in-class call center training program
  • Peer coach to observe you
  • Peer coach for you to observe
  • Open discussion conversations
  • A proven curriculum providing the knowledge you need to excel
  • A training lab where you take live calls with a training supervisor close by to answer questions

  Our comprehensive benefits package includes:

  • 401(k) retirement savings plan with company match
  • Subsidized health plans and free vision coverage
  • Life insurance
  • Paid annual leave – the longer you work here, the more you earn
  • Nine paid holidays
  • On-site cafeterias and fitness centers in major locations
  • Wellness programs and healthy lifestyle premium discount
  • Tuition assistance
  • Service recognition

  What to Expect Next

  After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.

  
  
  

  We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

  Equal Employment Opportunity Statement

  BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

  We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

  If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

• About the company

  When you hear "BlueCross BlueShield of South Carolina," you'll see people nodding in recognition. Most everyone knows who we are. As the only South Carolina-owned and operated health insurance carrier, we have been offering security to Palmetto State citizens for more than 70 years. We are also one of South Carolina's largest employers.

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