Bilingual Claims Customer Service Advocate II

Summary

Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non‑routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.

Full‑time (40 hours per week), Monday‑Friday in a typical office environment.

Work hours:

8:00AM‑4:30PM, with lunch from 11:30AM‑12:30PM. Training is on‑site at 4101 Percival Rd., Columbia, SC29229 for six weeks and you will be required to stay on‑site for 6 months. Remote work may be available based on performance.

• Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk‑in inquiries.
• Handle situations that may require adaptation of response or extensive research.
• Identify incorrectly processed claims and process adjustments and reprocessing actions according to department guidelines.
• Examine and process claims and/or non‑medical appeals in accordance with business/contract regulations, internal standards, and guidelines.
• Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Ensure claims are processed according to established quality and production standards.
• Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution.
• Identify and report potential fraud and abuse situations.

• High School Diploma or equivalent (or a Bachelor's Degree in lieu of work experience).
• Must be able to speak Spanish and English fluently.
• Minimum 2 years of customer service experience, including 1 year of claims or appeals processing.
• 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.

• Customer service experience.
• Call center experience.
• A positive attitude.

• Subsidized health, dental, and vision coverage.
• 401k retirement savings plan with company match.
• Life insurance.
• Paid Time Off (PTO).
• On‑site cafeterias and fitness centers in major locations.
• Education assistance.
• Service recognition.
• National discounts to movies, theaters, zoos, theme parks, and more.

Blue Cross Blue Shield 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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy‑related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email  or call 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. We participate in E‑Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.