FCMB Claims Customer Service Advocate II

2 weeks ago

Myrtle Beach, South Carolina, United States Palmetto GBA Full time
Summary
We have an FCMB Customer Service Advocate II job opening at BlueCross BlueShield of South Carolina. In this position, your duties include responding to routine correspondence and telephone inquiries related to claims or appeals. You will be tasked with identifying inaccurately processed claims, completing adjustments, and taking steps to reprocess them accordingly.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we have been part of the national landscape for more than seven decades, 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 committed 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), Monday through Friday, in a typical office environment. Employees are required to have the flexibility to work any of our 8-hour shifts scheduled during normal business hours. Given the business's need to work occasional overtime and weekends, this may be necessary. This role is located at 8733 Highway 17 Bypass, Myrtle Beach, SC 29575, United States of America.

What You'll Do:
  • 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.
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.
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 be conducting interviews with those candidates who qualify, 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.

Some states have required notifications. Here's more information.

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 or call , ext with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

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