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Customer Service Representative

4 months ago

Columbia, United States US Tech Solutions, Inc. Full time

Job Title: Customer Service Representative

Location: Columbia SC, 29229

Duration: 12 months contract(Possible Extension)


Job Description:

· Training 6 weeks onsite. No option for Remote.

· Medical background, office experience, customer service, previous call center experience Candidate would handle provider service calls, responding and answering any questions providers may have.

· Must have previous customer service and call center experience. We do not want any candidates without previous industry experience.

· Team is comprised of 17 people and the entire department has 80, close nit team environment.

Responsibilities:

· 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.

· 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.

· 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 reports potential fraud and abuse situations.

Experience:

· 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience

Skills:

· 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

Education:

· High School Diploma or equivalent