Claims Customer Service Advocate II

About the role

Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

Logistics

• Full-time (40 hours/week) Monday–Friday in a typical office environment.
• Flexibility to work any 8-hour shift scheduled during 9:00 AM – 6:00 PM.
• On-site training Monday–Friday 8:00 AM – 4:30/5:00 PM at 17 Technology Circle, Columbia, SC for approximately 6–8 weeks.
• Position located on site at 17 Technology Circle, Columbia, SC.
• Hours will not change due to contractual obligations.
• Requires the ability to obtain a security clearance; applicants must be U.S. Citizens.
• Subject to the Service Contract Act (SCA); employees must enroll in health insurance benefits; supplemental pay provided until benefits enrollment 28 days after hire.

Responsibilities

• Responds to written and/or telephone inquiries according to desk procedures, ensuring 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 complex-level complaints and inquiries 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 including 1 year 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 manage confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.

Preferred Qualifications

• Associate degree.
• 2 years of claims processing or call center experience.
• Knowledge of word processing, spreadsheet, and database software.

Benefits

• Subsidized health, dental, and vision coverage.
• 401(k) 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.
• Service recognition.
• Discounts to movies, theaters, zoos, theme parks, and more.