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Claims Customer Service Advocate II

Claims Customer Service Advocate II

Spectraforce TechnologiesColumbia, SC, United States
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Title Claims Customer Service Advocate II

Location : SC, 29229

Time :

  • 8 am - 5 pm Part-time. M-F 30-38 hours per week.

Duration : 3 Months, Contract to hire

Duties :

  • 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.
  • 45% 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.
  • 45% 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.
  • 10% 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.

    • Skills :

  • 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 Other Tools : Microsoft Office. Work Environment : Typical office environment.

    • Education :

  • Required Education : High School Diploma or equivalent Required Work Experience : 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience.
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