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FCMB Customer Service Advocate II

2 months ago

Myrtle Beach, South Carolina, United States BlueCross BlueShield of South Carolina Full time
Job Summary
We are seeking a highly skilled FCMB Customer Service Advocate II to join our team at BlueCross BlueShield of South Carolina. In this role, you will be responsible for responding to routine correspondence and telephone inquiries related to claims or appeals. Your duties will include identifying inaccurately processed claims, completing adjustments, and taking steps to reprocess them accordingly.

About the Role
This is a full-time position (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 our headquarters in Myrtle Beach, SC.

Key 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.
  • 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.
Requirements
  • 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
Preferred Qualifications
  • 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.