Summary
 

We are hiring a Customer Service Advocate II. In this role you will be 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.

The successful candidate for this position will be someone who pays strong attention to detail and is comfortable working in a high volume, fast-paced environment.

Description
 

Logistics

This position is full time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility work any our 8-hour shift scheduled during hours of 8:00 AM – 5:00 PM. Training will be Monday – Friday 8:00 AM -4:30/5:00 PM for approximately 6-8 weeks. This role is located on site at 4101 Percival Road 29229 United States of America.

What You will 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 will Need.

• A High School Diploma or equivalent
• 2-years of Customer service experience including 1-year claims OR appeals processing OR bachelor’s degree in lieu of work experience.

We Prefer That You Have

• Associate degree
• (3) years-of claims processing or call center experience.
• Knowledge of word processing, spreadsheet, and database software.
• 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.
• Microsoft Office.

What We Can Do for You

You are not alone. We are here to support you:

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and 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 b