Claims Customer Service Advocate I- Part Time

Summary We have a job opening for the position of Customer Service Advocate I at BlueCross BlueShield of South Carolina. In this role, you are responsible for responding to routine inquiries. Identify incorrectly processed claims and completes adjustments and related reprocessing actions. Review and adjudicate claims and/or non-medical appeals. Determine whether to return, deny or pay claims... following organizational policies and procedures. 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 have 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 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 job opportunity is located in W@H Richland County. Candidates must reside within a two-hour radius of the Percival Rd. office. The role involves working in a standard office setting, with part-time hours ranging from 20 to 38 per week and a flexible schedule that may include evenings and weekends. What You Will Do: Respond to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately document inquiries. Identify incorrectly processed claims and processes adjustments and reprocessing actions according to 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 are processing according to established quality and production standards. Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures, guidelines, and refer these to a lead or manager for resolution. Identify and promptly report and/or refer suspected fraudulent activities and system errors to the appropriate departments. To Qualify for This Position, You Will Need: High School Diploma OR equivalent 1 year of experience in a claims/appeals processing, customer service, or other related support area OR Bachelor's Degree in lieu of work experience. 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: Teaching or training 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 [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. Welcome CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, health care providers, and medical equipment suppliers in 33 states, supporting the needs of more than 20 million Medicare beneficiaries nationwide. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Want to work for a growing company with an innovative eye towards the future? Join us today

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