Claims Customer Service Associate I
3 months ago
Description
Logistics: This position is full-time (40 hours/week) in a typical office environment, Monday through Friday. There is an 8-week training period, and the hours during training are 8:00 AM—5:00 PM. Employees will work a schedule of 8:00 AM—5:00 PM/9:00 AM—6:00 PM. After completing training and meeting performance standards, there is a possibility of working at home. This role is on-site in Myrtle Beach, SC, reporting to our Surfside location.
What You’ll 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’ll Need
High School Diploma or equivalent
One year of experience in claims/appeals processing, customer service, or other related support areas 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 handle confidential or sensitive information with discretion.
Microsoft Office.
We Prefer That You Have
TRICARE customer service or claims experience.
What We Can Do for You
Our comprehensive benefits package includes:
401(k) retirement savings plan with company match Subsidized health plans and free vision coverage Life insurance Paid annual leave – the longer you work here, the more you earn Nine paid holidays On-site cafeterias and fitness centers in major locations Wellness programs and healthy lifestyle premium discount Tuition assistance Service RecognitionWhat to Expect Next
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Management will interview the most qualified candidates, prioritizing those who demonstrate the preferred qualifications.
Work Environment: Typical Office Environment.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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