FCMB Customer Service Advocate II

Summary

Responsible for responding to routine correspondence and telephone inquiries pertinent to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

From the moment of login, you’ll be focused on proactively resolving our members’ and/or providers’ questions and concerns using computer-based resources to find answers. Communication via telephone, written, web, or walk‑in inquiries. You will guide members and providers with their healthcare needs by explaining benefits, solving claim concerns, and helping find a doctor via telephone calls, online chats, or e‑mails. Occasionally, extensive research may be needed and it may be necessary to collaborate with other departments to find the answers needed.

Accurately documenting these questions is vital for the success of this role. You are the subject matter expert for this role. Your leadership team is open to your recommendations, feedback, process improvements, and assistance with special projects to make positive changes for the department. Once you have mastered this role, training and sharing your knowledge with new team members can be a rewarding part of this role.

PGBA

This position is full‑time (40 hours/week) Monday‑Friday in a typical office environment. Employees are required to have the flexibility to work any of our 8‑hour shifts scheduled during our normal business hours. It may be necessary, given the business need to work occasional overtime and weekends. This role is located at 200 North Dozier Boulevard Florence, SC 29501 United States of America.

• Researches and responds 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 and identify incorrectly processed claims and completes the adjustment and/or reprocessing action according to department guidelines. This may include initiating, documenting, and processing the request to completion. Initiate recoupments as necessary.
• Identifies complaints and inquiries of a complexity 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.
• Completes projects and/or assignments related to claims processing and customer service functions in the department.

• Required
  
  Education:
  
  High School Diploma or equivalent
• Required
  
  Work Experience:
  
  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.
• Required
  
  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.
• Required Software and Other Tools: Microsoft Office.
• Work Environment: Typical office environment.

• Strong human relations and organizational skills, with a demonstrated ability to handle high‑stress intense situations and conversations.
• Good judgment and the ability to handle confidential or sensitive information with discretion. Ability to learn.

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, 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…