FCMB Customer Service Advocate II

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. At times 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.

• →

  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.

• 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 understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

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 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 mycareer.help@bcbssc.com 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. Here's more information.

Some states have required notifications. Here's more information.