Summary
We are hiring a Customer Service Advocate. In this role you will be responsible for responding to responding to routine inquiries. You will identify incorrectly processed claims and completes adjustments and related reprocessing actions. You will also review and adjudicate claims and/or non-medical appeals and determine whether to return, deny or pay claims following organizational policies and procedures.
The successful candidate for this position will be someone who pays strong attention to detail and is comfortable working in a high volume, fast-paced environment.
Description
Logistics
This position is full time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility work any our 8-hour shift scheduled during hours of 8:00 AM – 5:00 PM. The training class start date is 11.4.2024. Training will be Monday – Friday 8:00 AM -4:30/5:00 PM for approximately 6-8 weeks. This role is located on site at 17 Technology Circle, Columbia SC.
What You will Do
- Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
- Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards.
- Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.
To Qualify for this Position, you will Need.
- A 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.
Job Type: Full-time
Pay: $17.20 per hour
Expected hours: No less than 40 per week
Benefits:
- 401(k)
- 401(k) 2% match
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Prescription drug insurance
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
- No nights
Experience:
- Microsoft Office: 1 year (Preferred)
- Customer service: 1 year (Required)
- Claims Processing: 1 year (Preferred)
Ability to Commute:
- Columbia, SC 29203 (Preferred)
Ability to Relocate:
- Columbia, SC 29203: Relocate before starting work (Required)
Work Location: In person
