Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina · Columbia, SC · 2 days ago

OTHRFull-time

PGBA, a subsidiary of BlueCross BlueShield of South Carolina, is seeking a claims/appeals processor. This full-time position (40 hours/week, Monday–Friday) is located on-site at 17 Technology Circle, Columbia, SC. Employees must be flexible to work any 8-hour shift scheduled between 9:00 AM and 6:00 PM. Training occurs Monday–Friday, 8:00 AM–4:30/5:00 PM on-site at the GPC location for approximately 6–8 weeks. Hours are fixed due to contractual obligations. This role requires the ability to obtain a security clearance (U.S. citizenship required). Under the Service Contract Act (SCA), employees must enroll in health insurance benefits regardless of other coverage; supplemental pay is provided until enrollment 28 days after hire.

Responsibilities

Respond to written and telephone inquiries per desk procedures, meeting contract standards for timeliness, productivity, and quality.
Accurately document inquiries.
Identify incorrectly processed claims and process adjustments and reprocessing actions per 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 process according to established quality and production standards.
Identify complex complaints and inquiries that cannot be resolved via desk procedures and refer to a lead or manager.
Identify and promptly report or refer suspected fraudulent activities and system errors to appropriate departments.

Requirements

High School Diploma or equivalent.
1 year of experience in claims/appeals processing, customer service, or related support area; OR a bachelor's degree in lieu of experience.
Good verbal and written communication skills.
Strong customer service skills.
Good spelling, punctuation, and grammar skills.
Basic business math proficiency.
Ability to manage confidential or sensitive information with discretion.
Proficiency with Microsoft Office.

Preferred Qualifications

Associate degree.
2 years of claims processing or call center experience.
Knowledge of word processing, spreadsheet, and database software.

Benefits

Subsidized health plans, dental and vision coverage.
401(k) retirement savings plan with company match.
Life insurance.
Paid Time Off (PTO).
On-site cafeterias and fitness centers in major locations.
Wellness program and healthy lifestyle premium discount.
Tuition assistance.
Service recognition.
Employee Assistance program.
Discounts to movies, theaters, zoos, theme parks, and more.

Schedule