FCMB Claims Customer Service Advocate II

📌 Core Information

🔹 Job Title: FCMB Claims Customer Service Advocate II

🔹 Company: PGBA

🔹 Location: Columbia, South Carolina, United States

🔹 Job Type: On-site

🔹 Category: 📞 Customer Service

🔹 Date Posted: March 29, 2025

🔹 Experience Level: 0-2 years

🔹 Remote Status: On-site

📌 Essential Job Details

🚀 Job Overview

Key aspects of this role include:

• Responding to routine correspondence and telephone inquiries regarding claims or appeals.
• Identifying incorrectly processed claims and executing adjustments.
• Ensuring compliance with contract standards for timeliness, productivity, and quality.
• Accurately documenting inquiries and processing adjustments as needed.

ASSUMPTION: Assumes the candidate is familiar with basic claims processing and customer service procedures. Details about specific claims types handled are not specified, indicating a general claims role.

📋 Key Responsibilities

✅ Respond to written and telephone inquiries following established procedures.

✅ Identify incorrectly processed claims and conduct necessary adjustments.

✅ Process claims and non-medical appeals as per business or contract regulations.

✅ Enter claim data after verifying correct coding of procedures and diagnoses.

✅ Report suspected fraudulent activities and system errors to the appropriate departments.

ASSUMPTION: Responsibilities imply proficiency with a claims processing system and basic knowledge of insurance claims procedures. Training likely provided for specific systems used.

🎯 Required Qualifications

Education: High School Diploma or equivalent

Experience: 1-year of experience in claims/appeals processing, customer service, or other related support areas, or a bachelor's degree in lieu of work experience.

Required Skills:

• Good verbal and written communication skills
• Strong customer service skills
• Basic business math proficiency

Preferred Skills:

• Associate degree
• 2 years of claims processing or call center experience

ASSUMPTION: Preferred skills suggest the benefit of higher education or extended industry experience. Microsoft Office proficiency implies familiarity with computer-based work environments.

💰 Compensation & Benefits

Salary Range: Not specified

Benefits:

• Subsidized health plans, dental, and vision coverage
• 401K retirement savings plan with company match
• Life insurance
• Paid Time Off (PTO)
• Wellness programs and education assistance

Working Hours: Flexible 8-hour shifts scheduled between 10:00 AM and 7:00 PM

ASSUMPTION: Flexible work hours suggest a need for adaptability to different schedules. Benefits imply a stable full-time role with comprehensive employee benefits.

📌 Applicant Insights

🔍 Company Context

Industry: Insurance

Company Size: 10,001+ employees

Founded: 1946

Company Description:

• Largest insurance company in South Carolina with a long-standing history
• A-rated by A.M. Best for financial stability
• Offers diverse employment opportunities and career growth

Company Specialties:

• Health Care Insurance
• Information Technology
• Data Processing

Company Website: https://www.southcarolinablues.com/web/public/brands/sc/blog/

ASSUMPTION: Attributes the company's strength to its extensive history and capabilities in managing government contracts, reflecting stability for potential employees.

📊 Role Analysis

Career Level: Entry to early career

Reporting Structure: Likely reports to a department manager or team lead

Work Arrangement: On-site position in a corporate office setting

Growth Opportunities:

• Advancement into specialized claims roles or management
• Opportunities for training and development within a large company
• Potential progression into roles handling more complex claims

ASSUMPTION: Opportunities for advancement are implied by the company's size and industry, offering structured career paths and professional development.

🌍 Location & Work Environment

Office Type: Professional corporate office environment

Office Location(s): 17 Technology Circle, Columbia, SC

Geographic Context:

• Situated in a central business area
• Accessibility to local amenities and services
• Potential commuter benefits in a business district

Work Schedule: Standard office hours with some shift flexibility

ASSUMPTION: Many local businesses and amenities suggest ease of access to dining and services, appealing to professionals working in the area.

💼 Interview & Application Insights

Typical Process:

• Resume review and qualification screening
• Initial phone interview or email communication
• In-person interviews for qualified candidates

Key Assessment Areas:

• Claims processing knowledge
• Customer service proficiency
• Communication skills

Application Tips:

• Highlight any claims processing background
• Emphasize customer service and communication skills
• Prepare to discuss flexibility and adaptability

ATS Keywords: Claims Processing, Customer Service, Communication Skills, Microsoft Office

ASSUMPTION: Based on role responsibilities, assumes assessment will focus on communication and technical skills related to claims handling.

🛠️ Tools & Technologies

• Microsoft Office
• Claims Processing Systems

ASSUMPTION: Assumes general proficiency in common office software and specialized claims software used in insurance industries.

👔 Cultural Fit Considerations

Company Values:

• Commitment to customer satisfaction
• Integrity and transparency in operations
• Inclusivity and diversity in the workplace

Work Style:

• Collaborative team environment
• Adaptable to shifts and schedule changes
• Customer-focused mindset

Self-Assessment Questions:

• Am I comfortable meeting performance metrics for claims processing?
• How do I handle challenging customer service situations?
• Can I work flexible hours as required?

ASSUMPTION: Company values suggest a supportive environment committed to employee growth and customer care, important attributes for prospective applicants.

⚠️ Potential Challenges

• Handling complex customer inquiries
• Managing workload during peak times
• Navigating procedural updates and changes
• Adapting to new claims processing technology

ASSUMPTION: Challenges are typical for roles in claims and customer service, particularly in handling workload fluctuations and maintaining service standards.

📈 Similar Roles Comparison

• Other roles might require more specialized claims knowledge
• Some positions may offer more remote work flexibility
• Similar roles in smaller companies might have broader job duties

ASSUMPTION: Assumes roles in this field vary by company size and scope, with potential additional responsibilities in smaller settings.

📝 Sample Projects

• Improving claim processing efficiencies
• Developing customer service training modules
• Identifying system improvements for claims management

ASSUMPTION: Projects are typically related to process enhancements and customer service, common in insurance industries.

❓ Key Questions to Ask During Interview

• How does your team handle high volumes of claims?
• What training and development opportunities are available?
• Can you describe a typical career path in this role?
• What are the most challenging aspects of this position?
• How do you measure success in this role?

ASSUMPTION: Questions focus on understanding the scope, support, and progression within the role, significant for evaluating fit and growth potential.

📌 Next Steps for Applicants

To apply for this position:

• Submit your application through the BlueCross BlueShield of South Carolina careers page.
• Ensure your resume highlights relevant claims processing and customer service experience.
• Prepare for a phone screening by reviewing common customer service scenarios.
• Research the company's history and culture to better understand their values.
• Gather questions to ask about the team's dynamics and growth opportunities during your interview.

⚠️ This job description contains AI-assisted information. Details should be verified directly with the employer before making decisions.