Claims Customer Service Advocate II

We are the largest insurance company in South Carolina and a leading administrator of government contracts, operating one of the most sophisticated data processing centers in the Southeast. Our diverse family of subsidiary companies delivers outstanding service to customers, with roots firmly embedded in the South Carolina community for over seven decades.

About the role

This is a full-time (40 hours/week), hybrid position based at 26 Century Blvd Suite 610, Nashville, TN 37214. You will work 3 days in the office and 2 days remotely, Monday through Friday in a typical office environment.

Responsibilities

• Respond accurately, timely, and courteously to telephone, written, web, or walk-in inquiries, handling non-routine situations that may require adaptation or extensive research.
• Identify incorrectly processed claims and process adjustments and reprocessing actions according to department guidelines.
• Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines.
• Enter claims into the claim system after verifying correct coding of procedures and diagnosis codes.
• Ensure claims are processed according to established quality and production standards.
• Identify complex complaints and inquiries that cannot be resolved following desk procedures and refer them to a lead or manager.
• Identify and report potential fraud and abuse situations.

Requirements

• High School Diploma or equivalent.
• 2 years of customer service experience, including 1 year of claims or appeals processing, or a 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.
• Proficiency with 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.
• Education Assistance.
• Service Recognition.
• National discounts to movies, theaters, zoos, theme parks, and more.

Benefits eligibility begins the first of the month following 28 days of employment.