**Experienced Part-Time Claims Customer Service Advocate I – Insurance Industry Professional**

**Join Our Dynamic Team at BlueCross BlueShield of South Carolina** Are you passionate about delivering exceptional customer service and making a meaningful impact in the lives of others? Do you have a keen eye for detail and a knack for resolving complex issues? If so, we invite you to join our team as a Part-Time Claims Customer Service Advocate I at BlueCross BlueShield of South Carolina. As a valued member of our team, you will play a critical role in ensuring that our customers receive the highest level of service and support. **About Us** BlueCross BlueShield of South Carolina is a leading health insurance company with a rich history spanning over seven decades. We are proud to be part of the national landscape, with our roots firmly embedded in the South Carolina community. As one of the largest insurance companies in South Carolina, we offer a wide range of health insurance products and services to individuals, families, and businesses. Our commitment to delivering outstanding service to our customers has earned us a reputation as a trusted and reliable partner in the healthcare industry. **Why Join Our Team?** At BlueCross BlueShield of South Carolina, we value our employees and offer a supportive and inclusive work environment that fosters growth and development. We believe in investing in our people and providing them with the tools and resources they need to succeed. Our team members enjoy a range of benefits, including: * Competitive salaries and bonuses * Comprehensive health insurance plans * Retirement savings plans * Paid time off and holidays * Opportunities for professional growth and development * A dynamic and supportive work environment **Job Summary** We are seeking an experienced Part-Time Claims Customer Service Advocate I to join our team. As a key member of our customer service team, you will be responsible for responding to routine inquiries, identifying incorrectly processed claims, and completing adjustments and related reprocessing actions. You will also review and adjudicate claims and/or non-medical appeals, determine whether to return, deny or pay claims, and ensure that all actions are taken in accordance with organizational policies and procedures. **Key Responsibilities** * Respond to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. * Accurately document inquiries and maintain accurate records. * Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines. * Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines. * Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes. * Ensure claims are processing according to established quality and production standards. * Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures, guidelines, and refer these to a lead or manager for resolution. * Identify and promptly report and/or refer suspected fraudulent activities and system errors to the appropriate departments. **Essential Qualifications** * High School Diploma or equivalent * 1 year of experience in a claims/appeals processing, customer service, or other related support area * 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 proficiency **Preferred Qualifications** * Teaching or training experience **What We Offer** * Competitive salary and bonus structure * Comprehensive health insurance plans * Retirement savings plans * Paid time off and holidays * Opportunities for professional growth and development * A dynamic and supportive work environment **Work Environment** * This job opportunity is located in West Columbia, Richland County. * Candidates must reside within a two-hour radius of the Percival Rd. office. * The role involves working in a standard office setting, with part-time hours ranging from 20 to 38 per week and a flexible schedule that may include evenings and weekends. **How to Apply** If you are a motivated and customer-focused individual who is passionate about delivering exceptional service, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, to our online application system. We look forward to reviewing your application and welcoming you to our team! **Equal Employment Opportunity Statement** 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 minorities, females, disabled individuals, and 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 physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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. Apply for this job