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Title: Claims Customer Service Advocate IILocation: Columbia, SC 29229 (contract to hire )Duration: 3 months assignmentShift- Monday-Friday, 7:30AM-4:00PMNote: MANAGER WILL CONDUCT IN PERSON INTERVIEWS ONSITE POSITION ONLYDuties: - Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures.
- Performs research as needed to resolve inquiries.
- Reviews and adjudicates claims and/or non-medical appeals.
- Determines whether to return, deny or pay claims following organizational policies and procedures.
- 45% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
- Handles situations which may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
- 45% 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.
- 10% 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 reports potential fraud and abuse situations.
Skills: - Required Skills and Abilities: 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.
- Required Software and Other Tools: Microsoft Office. Work Environment: Typical office environment.
Education: - Required Education: High School Diploma or equivalent Required
- Work Experience: 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience.
Date Posted: 17 April 2025
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