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FCMB Claims Customer Service Advocate II

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BlueCross BlueShield of South Carolina

Aug 29, 2024

  • Job
    Full-time
    Junior Level
  • Myrtle Beach
  • Quick Apply

AI generated summary

  • You need a high school diploma, strong communication and customer service skills, basic math, and Microsoft Office proficiency. Preferably, have 2 years of customer service or claims experience.
  • You will respond to inquiries, adjust claims, initiate recoupments, resolve complex issues, report fraud, and complete related projects in claims processing and customer service.

Requirements

  • To Qualify For This Position, You'll Need
  • High School Diploma or equivalent
  • 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 Prefer
  • 2 years of customer service experience OR 1 year of claims or appeals processing experience and 1 year of customer service experience OR Bachelor's Degree in lieu of work experience.

Responsibilities

  • Research and respond to telephone inquiries according to desk procedures, ensuring that 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. This may include initiating, documenting, and processing the request to completion.
  • Initiate recoupments as necessary.
  • Identify complaints and inquiries of a complex level that cannot be resolved by following desk procedures and guidelines and referring them 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 claim processing and customer service functions.

FAQs

Do we support remote work?

This position is not remote; it requires full-time work in a typical office environment located in Myrtle Beach, SC.

What are the working hours for this position?

The working hours for this position are full-time (40 hours/week), Monday through Friday, with flexibility to work any of the 8-hour shifts scheduled during normal business hours.

What type of customer service experience is preferred?

We prefer candidates with 2 years of customer service experience, or 1 year of claims or appeals processing experience along with 1 year of customer service experience, or a Bachelor's Degree in lieu of work experience.

Is there an opportunity for overtime or weekends?

Yes, there may be a need to work occasional overtime and weekends based on the business's needs.

Are there specific skills required for this position?

Yes, candidates should possess good verbal and written communication skills, strong customer service skills, basic business math proficiency, and proficiency in Microsoft Office.

What should I expect after submitting my application?

After submitting your application, our recruiting team will review your resume, which may lead to a brief telephone interview or email communication to verify specifics before management conducts interviews.

Is there an equal opportunity employment policy?

Yes, BlueCross BlueShield of South Carolina maintains a continuing policy of nondiscrimination in employment and is committed to equal opportunities in all phases of the employment process.

How do I request a reasonable accommodation during the application process?

If you need special assistance or an accommodation while seeking employment, you can email mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with your request.

What is the primary responsibility of this role?

The primary responsibility of this role includes responding to routine correspondence and telephone inquiries related to claims or appeals, identifying inaccurately processed claims, making adjustments, and reprocessing them accordingly.

Is training provided for new hires in this position?

The specific job description does not mention training, but typically organizations provide onboarding and training to ensure employees are familiar with procedures and systems.

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BlueCross BlueShield of South Carolina

South Carolina’s largest and oldest health insurance company

Finance
Industry
10,001+
Employees
1946
Founded Year

Mission & Purpose

BlueCross BlueShield of South Carolina, the state's largest insurance company, has been a part of the national landscape for over six decades. With an A+ Superior rating from A.M. Best, the company is a leading government contract administrator and operates one of the most advanced data processing centers in the Southeast. BlueCross offers employees robust benefits, including retirement plans, health coverage, and education assistance, while fostering a culture of community support, with employees actively contributing to numerous nonprofit organizations each year.