Title: Customer Service Advocate I
Location: Columbia, SC 29229(Contract to hire)
Duration: 3 months assignment
Shift- M-F 8:30-5:00
1 opening per shift. M-F 8:30-5:00. 1 hour lunch break.
ONSITE INTERVIEWS.
TRAINING WILL BE 6 WEEKS. THE FIRST 3 DAYS WILL BE ONSITE. THE FIRST 5 WEEKS WILL BE VIRTIAL AND THE LAST WEEK WILL BE ON SITE. 
Duties:

• 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.
• 40% 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.
• 40% 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.
• 20% 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. 

 
Skills:

• Required Skills and Abilities: 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.
• Required Software and Other Tools: Microsoft Office.
• Work Environment: Typical Office Environment.

 
Education:

• Required Education: High School Diploma or equivalent Required Work Experience: None Preferred Education: Associate Degree Preferred Work Experience: 2 years-of customer service or call center experience.

 

 


At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $18.00/hr.