Summary
 

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.

Description
 

Location:

This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour flexible shift during the hours of 8:00am – 8:00pm. It may be necessary, given the business need to work occasional overtime. This role onsite is located at 4101 Percival Road, Columbia SC., 29203.

What You’ll Do:

• 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.
• 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 reports potential fraud and abuse situations.

To Qualify for This Position, You’ll Need the Following:

• 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.
• 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 Tools:
• Proficiency with Microsoft Office Products.

What Prefer That You Have the Following:

• Associate degree
• Prefer (2) years claims experience and/or Healthcare Management
• 1-2 years in a healthcare environment, i.e. doctor office, hospital, urgent care, etc.
• 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.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• 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
• Tuiti