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 per week) Monday through Friday in a typical office environment. This role is located at 4101 Percival Rd, Columbia 29229. Employees are required to have the flexibility to work any 8-hour shift during the hours of 8:00 AM - 6:00 PM to include overtime as needed. Training hours are Monday through Friday 8:00 AM - 4:30 PM for six weeks.

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

• 2 years of customer service experience including 1-year claims or appeals processing 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 handle confidential or sensitive information with discretion.

• Microsoft Office.

What We can Do for You:

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

• Tuition assistance

• Service recognition

• Employee Assistance

• Discounts to movies, theaters, zoos, theme parks and more

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