Summary
 

We are currently hiring for a Claims Customer Service Advocate I to join BlueCross BlueShield of South Carolina. In this role, you will be responsible for responding to routine inquiries, identifying incorrectly processed claims and completing adjustments and related reprocessing actions. You will also review and adjudicate claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description
 

Logistics​: This position is full-time (40 hours/week) in a typical office environment, Monday through Friday. There is an 8-week training period, and the hours during training are 8:00 AM—5:00 PM. Employees will work a schedule of 8:00 AM—5:00 PM/9:00 AM—6:00 PM. After completing training and meeting performance standards, there is a possibility of working at home. This role is on-site in Myrtle Beach, SC, reporting to our Surfside location.

What You’ll Do

• Responds 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. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.

• Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards.

• Identifies 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. Identifies 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

• One year of experience in claims/appeals processing, customer service, or other related support areas 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.

We Prefer That You Have

• TRICARE customer service or claims experience.

What We Can Do for You

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

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. Management will interview the most qualified candidates, prioritizing those who demonstrate the preferred qualifications.

Work Environment: Typical Office Environment.

 

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

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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 [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.