Claims Customer Service Advocate I-Part Time

Company: BlueCross BlueShield of South Carolina
Location: Greenville
Posted on: March 16, 2023

Job Description:

SummaryPosition Purpose:In the role as the Claims Customer Service Advocate I, one will be responsible for responding to routine inquiries and claims processing. The ideal candidate will be efficient, have problem solving and organizational skills, and be detail oriented. As a Claims Customer Service Advocate I, one will identify incorrectly processed claims, completes adjustments and related reprocessing actions. In this role, one will review and adjudicate claims and/or non-medical appeals and determine whether to return, deny, or pay claims following organizational policies and procedures.DescriptionClaims Customer Service Advocate I (PART-TIME)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!Logistics:This position is part-time position (30 hours per week) Monday through Friday. Employees are required to have the flexibility to work any 6-hour shift during the hours of 8:30am-2:30 pm reporting onsite to 1000 Executive Center Drive, Greenville, SC 29615. 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 metAccurately document inquiriesIdentify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelinesExamine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelinesEnter claims into the claim system after verification of correct coding of procedures and diagnosis codesEnsure claims are processing according to established quality and production standardsIdentify 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 report and/or refer suspected fraudulent activities and system errors to the appropriate departmentsTo Qualify for This Position, You'll Need:1 year of experience in a claims/appeals processing, customer service, or other related support area OR Bachelor's Degree in lieu of work experienceHigh School Diploma or equivalentAbility to answer phonesAbility to follow policies and proceduresAbility to navigate systemsAbility to process claimsAbility to research inquiriesAbility to review claims and appealsWhat We can Do for You:We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage401K retirement savings plan with company matchLife InsurancePaid Time Off (PTO)On-site cafeterias and fitness centers in major locationsWellness program and healthy lifestyle premium discountTuition assistanceService recognitionEmployee AssistanceDiscounts to movies, theaters, zoos, theme parks and moreWhat to Expect Next:After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications require proof of semester hours, please attach your transcript to your application.Management will be conducting interviews with the most qualified candidates, with prioritization given to those candidates who demonstrate the preferred qualifications.We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Equal Employment Opportunity StatementBlueCross 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.

Keywords: BlueCross BlueShield of South Carolina, Greenville , Claims Customer Service Advocate I-Part Time, Other , Greenville, South Carolina