Claims Customer Service Advocate I

Responsibilities

• 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.
• Ensure claims are processed 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.

Requirements

• Required Education: High School Diploma or equivalent
• Required Work Experience: 1 year of experience in claims/appeals processing, customer service, or other related support area OR Bachelor's Degree in lieu of work experience
• 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 Tools: Microsoft office

Qualifications

To qualify for this position, you’ll need the following:

• High School Diploma or equivalent
• 1 year of experience in 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 handle confidential or sensitive information with discretion
• Microsoft office

Benefits

• Subsidized health plans, dental and vision coverage
• 401K retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Discounts to movies, theaters, zoos, theme parks and more