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Claims Customer Service Advocate II

4 months ago

Columbia, United States Spectraforce Technologies Full time
Title: Claims Customer Service Advocate II

Location: Columbia, SC, 29229

Duration: 5 months assignment (Contract To Perm)

Shift: Start time- 7:45am or 8:00am (Monday- Friday)

Note:

Onsite role.

Skill sets/qualities: Data Entry Experience, Organizational Skills.

Ability to follow instructions with limited supervision.

Flexibility when daily responsibilities change.

claims entry for submitted claims.

Soft skills (communication, leadership, adaptable etc.) that you would like candidates to have and the importance of these skills for this role

Duties:
  • 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 that 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 processed 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.