Customer Service Advocate II

This position is full-time (40 hours/week) Monday–Friday in a typical office environment. Employees must maintain flexibility to work any 8-hour shift scheduled between 8:00 AM and 6:00 PM due to contractual obligations. Training runs Monday–Friday from 8:00 AM–5:00 PM for approximately 6–8 weeks. The role is located on site at 17 Technology Circle, Columbia, SC. This position is not eligible for sponsorship now or in the future.

About the role

Provides prompt, accurate, thorough, and courteous responses to all customer inquiries, including non-routine inquiries that require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.

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 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: A 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

Qualifications

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

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
• Service recognition
• Discounts to movies, theaters, zoos, theme parks and more