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Claims Customer Service Advocate II at Spectraforce Technologies
Spectraforce Technologies
Columbia, South Carolina
Administration
Posted 1 days ago
Job Description
Title Claims Customer Service Advocate II
Location: SC, 29229
Time: * 8 am - 4:30 pm
Duration: 3 Months, Contract to hire
Duties:
Skills:
Education:
Location: SC, 29229
Time: * 8 am - 4:30 pm
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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