FCMB Customer Service Advocate II

3 days ago


Myrtle Beach, South Carolina, United States BlueCross BlueShield of South Carolina Full time
FCMB Customer Service Advocate II Job Summary

We are seeking a highly skilled and detail-oriented 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, identifying inaccurately processed claims, and taking steps to reprocess them accordingly.

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.

We are an equal opportunity employer and comply with the Pay Transparency Nondiscrimination Provision. We participate in E-Verify and 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.



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