Customer Service Advocate III

Bluecross Blueshield Of South Carolina Columbia , SC 29209

Posted Yesterday

Summary

This is a Non Phone Customer Service position. Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.

Description

  • 65% Responsible for accurate and timely response to complex telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Maintain all departmental productivity, quality and timeliness standards.
  • 15% Initiate corrective actions, process adjustments, or perform other research to resolve inquiries. Evaluate inquiries to identify underlying causes and implement actions to prevent future issues. Coordinate with other departments to resolve problems.
  • 10% Provide feedback to management regarding customer issues. Maintain accurate records concerning issues. Follow through on complaints until resolved or report to management as needed.
  • 5% Maintain knowledge of procedures and policies. Assist with process improvements by recommending improvements in procedures and policies.
  • 5% Assist with the training of new employees and cross training of coworkers.

Required Work Experience:

  • Two Years Customer service or claims processing experience OR
  • Bachelor's Degree in lieu of work experience.

Required Education:

  • High School Diploma or equivalent

Required Skills and Abilities:

  • Strong oral and written communication skills.

  • Proficient in spelling, punctuation, and grammar.

  • Strong organizational, strong analytical, and customer service skills.

  • Ability to handle high stress situations.

  • Basic business math proficiency.

  • Ability to handle confidential or sensitive information with discretion.

  • Ability to learn and operate multiple computer systems effectively and efficiently.

Required Software and Other Tools:

  • Experience with Microsoft Office.

Preferred Skills and Abilities:

  • AMMS and ITS Claims processing experience

  • Pharmacy Claims processing experience

  • Ability to persuade, negotiate or influence.

Preferred Software and Other Tools:

  • Knowledge of database software.

  • Microsoft Excel knowledge

  • Microsoft Access knowledge

Additional Job Description:

  • This is a non-call center customer service position.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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 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.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Claims Customer Service Advocate II

Bluecross Blueshield Of South Carolina

Posted Yesterday

VIEW JOBS 12/5/2019 12:00:00 AM 2020-03-04T00:00 Summary Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description * 45% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines. * 45% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards. * 10% Identifies 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. Identifies and reports potential fraud and abuse situations. Required Education: * High School Diploma or equivalent Required Work Experience: * Two years of customer service experience including One year claims or appeals processing OR * Bachelor's Degree in lieu of work experience. Skills and Abilities: * 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. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. 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 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. Bluecross Blueshield Of South Carolina Columbia SC

Customer Service Advocate III

Bluecross Blueshield Of South Carolina