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
 

Logistics

This position is full time (40 hours/week) Monday-Friday and will be located in Augusta, GA.

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:

• High School Diploma or equivalent.
• Two Years Customer service or claims processing experience 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 abilities.
• Ability to handle confidential or sensitive information with discretion.
• Microsoft Office.

What We Can Do for You:

• 401(k) retirement savings plan with company match.
• Fantastic health plans and free vision coverage.
• Life insurance.
• Paid annual leave — the longer you work here, the more you earn nine paid holidays.
• Onsite cafeterias and fitness centers in significant locations.
• Wellness programs and a healthy lifestyle premium discount.
• Tuition assistance.
• Service Recognition.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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