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Customer Service Advocate II
BlueCross BlueShield of South Carolina. Provide prompt, accurate, thorough and courteous responses to customer inquiries .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing and customer service, with a strong focus on accuracy, quality, and adherence to business regulations. Proficient in managing sensitive information and effectively communicating with customers to resolve inquiries.
Highest-signal resume keywords
Claims ProcessingCustomer ServiceVerbal Communication SkillsWritten Communication SkillsBusiness Math Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingAppeals ProcessingDocumentationData EntryQuality Standards
Soft Skills
Customer Service SkillsAttention to DetailDiscretion
Tools & Technologies
Microsoft OfficeWord Processing SoftwareSpreadsheet SoftwareDatabase Software
Industry Keywords
Contract RegulationsFraudulent Activity ReportingNon-Medical Appeals
About the role
Key responsibilities & impact- Provide prompt, accurate, thorough and courteous responses to customer inquiries
- Research inquiries as needed to resolve them
- Respond to written and telephone inquiries according to desk procedures
- Meet contract standards and objectives for timeliness, productivity and quality
- Accurately document inquiries
- Identify incorrectly processed claims and process adjustments and reprocessing actions
- Examine and process claims and non-medical appeals according to business and contract regulations
- Enter claims into the claim system after verifying procedure and diagnosis coding
- Meet established quality and production standards
- Identify complex complaints and inquiries and refer unresolved matters to a lead or manager
- Report or refer suspected fraudulent activity and system errors to appropriate departments
Requirements
What you’ll need- High School Diploma or equivalent
- 1 year of experience including 1 year 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 Manage Confidential or Sensitive Information with Discretion
- Microsoft Office
- Sponsorship is not eligible now or in the future
- Preferred: Associate degree
- Preferred: 2 years of claims processing or call center experience
- Preferred: Knowledge of word processing, spreadsheet, and database software
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
- Reasonable accommodations for qualifying individuals
- W@H after training, equipment issuance and performance evaluation and LOB business needs review