Summary
 

Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.

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 8am - 6pm due to contractual obligations. Training will be Monday – Friday 8:00 AM 5:00 PM for approximately 6-8 weeks. This role is located on site at 4101 Percival Road, Columbia SC. This position is HYBRID based upon onsite performance competency and LOB needs.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You’ll Do:

• Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed. Research to identify cause and mine ways to prevent and correct such causes. Identifies and reports potential fraud and abuse situations.

• Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity and quality are met. Handles situations that require adaptation of response or extensive research.

• 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. Ensure claims are processed according to established quality and production standards.

• Provide feedback to management regarding customer issues. Maintain accurate records concerning issues. Follow through on complaints until resolved or report to management as needed.

• Maintain knowledge of procedures and policies. Assist with process improvements by recommending improvements in procedures and policies. Assists in training claims customer service representatives.

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

• Required Education:

• High School Diploma or equivalent

• Required Work Experience:

• 3 years of customer service experience, including 1 year of claims or appeals processing experience 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 abilities.

• Ability to handle confidential or sensitive information with discretion.

We Prefer You Have the Following:

• 1 year of experience with ACA preferred.

• 3 Years-Customer service or claims processing experience.

• Associate degree-Any Major

• Ability to persuade, negotiate or influence.

• Knowledge of database software.

• Cohere Experience, Genesys, and Bluesteps.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits for 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

• Education Assistance

• Service Recognition

• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers, and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you m