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FCMB Claims Customer Service Advocate II ( Myrtle Beach) id-5520

About the position

As a Claims Customer Service Advocate II at BlueCross BlueShield of South Carolina, you will play a vital role in our Government Customer Service team. This position involves responding to routine correspondence and telephone inquiries regarding claims or appeals. You will be tasked with identifying incorrectly processed claims and executing necessary adjustments and reprocessing actions. Your contributions will help ensure that our customers receive the highest level of service and support, reflecting our commitment to excellence in the insurance industry. In this full-time role, you will work Monday through Friday from 8:00 AM to 5:30 PM EST, primarily on-site in Myrtle Beach, SC.

The position requires participation in a mandatory three-month training program, which will also be conducted on-site. Following successful completion of the training, there may be opportunities for remote work based on your performance. Your responsibilities will include researching and responding to telephone inquiries in accordance with established desk procedures, ensuring compliance with contract standards and objectives for timeliness, productivity, and quality. You will also be responsible for addressing written inquiries, identifying incorrectly processed claims, and completing the necessary adjustments or reprocessing actions as per department guidelines.

 This may involve initiating, documenting, and processing requests to completion. Additionally, you will initiate recoupments when necessary, identify complex complaints and inquiries that require escalation to a lead or manager, and report potential fraud and abuse situations. Your role will also include completing various projects and assignments related to claims processing and customer service functions, all within a typical office environment. It is important to note that obtaining a government (C-2) clearance will be a requirement for this position.

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Responsibilities

  • Research and respond to telephone inquiries according to desk procedures, ensuring contract standards and objectives for timeliness, productivity, and quality are met.
  • Research and respond to written inquiries, identify incorrectly processed claims, and complete the adjustment and/or reprocessing action according to department guidelines.
  • Initiate recoupments as necessary.
  • Identify complaints and inquiries of a complexity level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution.
  • Identify and report potential fraud and abuse situations.
  • Complete projects and/or assignments related to the department's claims processing and customer service functions.

Requirements

  • High School Diploma OR equivalent.
  • Good verbal and written communication skills.
  • Strong customer service skills.
  • Good spelling, punctuation, and grammar skills.
  • Ability to handle confidential or sensitive information with discretion.

Nice-to-haves

  • Two years of customer service experience OR one year of claims or appeals processing experience and one year of customer service experience OR a bachelor's degree in place of work experience.

Benefits

  • 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.
  • Incentive Plan.
  • Merit Plan.
  • Continuing education funds for additional certifications and certification renewal.
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