Summary
 

Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. 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. Employees are required to have flexibility work any our 8-hour shift scheduled during hours of 8:00 AM – 8:00 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 17 Technology Circle, Columbia SC. 

***This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. ***

What You will Do

• Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. 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 promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

To Qualify for this Position, you will Need.

• A High School Diploma or equivalent
• 1-year of experience including 1-year claims/appeals processing, customer service, or other related support area 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 Manage Confidential or Sensitive Information with Discretion.
• Microsoft Office.

We Prefer That You Have

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

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

• Classroom and Lab Training
• Best in class call center training program
• A classroom environment, live trainer, and open discussion
• A proven curriculum providing the knowledge you need to excel.
• A training lab where you take live calls with a training supervisor close by to answer questions.

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 cafeteria