Claims Processor

Job Summary :

We are seeking a motivated and detail-oriented Customer Service Representative to join our team. As a Customer Service Representative, you will be responsible for responding to customer inquiries, reviewing and adjudicating claims and appeals, and ensuring effective customer relations.

This position requires strong communication skills, attention to detail, and the ability to handle confidential information with discretion.

Join our team and contribute to providing excellent customer service in the healthcare industry.

Job Specifications :

• Job Type : Temp-to-hire
• Company : Kelly® Professional & Industrial
• Location : Columbia, SC
• Pay Rate : $15.00+ per hour
• Shift : between 8 : 00am - 8pm, Monday-Friday (40 hours per week)

Roles and Responsibilities :

• Respond accurately, timely, and courteously to telephone, written, web, or walk-in inquiries from customers
• Perform research as needed to resolve non-routine inquiries
• Review and adjudicate claims and non-medical appeals following organizational policies and procedures
• Determine whether to return, deny, or pay claims
• Identify incorrectly processed claims and process adjustments and reprocessing actions
• Examine and process claims and non-medical appeals according to business / contract regulations and internal standards
• Enter claims into the claim system after verifying correct coding of procedures and diagnosis codes
• Ensure claims are processing according to established quality and production standards
• Identify and report potential fraud and abuse situations
• Refer complex complaints and inquiries to a lead or manager for resolution

Qualifications & Skills :

• High School Diploma or equivalent required
• 2 years of customer service experience including 1 year of claims or appeals processing 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
• Proficiency in Microsoft Office

Opportunities :

• Opportunity to contribute to the healthcare industry by ensuring accurate claims processing and customer satisfaction
• Potential for career growth and advancement within the company
• Collaborative work environment with a focus on teamwork and professional development

Company Culture :

At Kelly® Professional & Industrial, we value our employees and believe in providing a supportive and inclusive work environment.

We are committed to helping our employees discover their potential and grow in their careers. Join our team and be part of a premiere company that values your skills and contributions.

What happens next :

If your skills and experience align with the requirements of this position, you will proceed to the next steps in the application process.

Even if this particular position doesn't work out, your profile will remain in our network, giving you access to a wide range of opportunities.

Helping you discover what's next in your career is our priority. Apply today to be a Customer Service Professional and let's work together towards your professional growth.9369177