Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina

. Respond to customer inquiries by telephone, written communication, web, or walk-in interactions .

Posted 9/18/2026full-timeColumbia • South Carolina • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims processing and customer service, with a strong ability to handle complex inquiries and maintain confidentiality. Proficient in adapting procedures and ensuring compliance with organizational policies and regulations.

Highest-signal resume keywords

Claims ProcessingCustomer ServiceVerbal CommunicationWritten CommunicationBusiness Math Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationClaims AdjustmentProcedure CodingDiagnosis CodingFraud Identification

Soft Skills

Problem SolvingAttention to DetailDiscretion

Tools & Technologies

Microsoft Office

Industry Keywords

Non-Medical AppealsOrganizational PoliciesQuality StandardsProduction Standards

About the role

Key responsibilities & impact

Respond to customer inquiries by telephone, written communication, web, or walk-in interactions
Research and resolve non-routine or complex inquiries requiring adaptation of standard screens, scripts, and procedures
Review and adjudicate claims and/or non-medical appeals
Determine whether to return, deny, or pay claims according to organizational policies and procedures
Identify incorrectly processed claims and process adjustments and reprocessing actions
Examine and process claims and non-medical appeals according to business and contract regulations, internal standards, and examining guidelines
Enter claims into the claim system after verifying correct procedure and diagnosis coding
Process claims according to established quality and production standards
Escalate complex complaints and inquiries to a lead or manager
Identify and report potential fraud and abuse situations

Requirements

What you’ll need

High School Diploma or equivalent
2 years of customer service experience including 1 year of claims or appeals processing experience 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
This position is not eligible for sponsorship now or in the future
Flexibility to work any 8-hour shift scheduled between 8:00 AM - 5:00 PM, Monday through Friday
Full-time availability of 40 hours per week

Benefits

Comp & perks

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
Wellness program and healthy lifestyle premium discount
Tuition assistance
Service recognition
Employee Assistance
Discounts to movies, theaters, zoos, theme parks and more
Diverse and inclusive workplace with opportunities to develop skills, advance careers and contribute to company growth
Reasonable accommodations for qualifying individuals