Title Claims Customer Service Advocate II
Location: SC, 29229
Time: * 8 am - 5 pm Part-time. M-F 30-38 hours per week.
Duration: 3 Months, Contract to hire
 
Duties:

• 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.
• 45% 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.
• 45% 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.
• 10% 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.

 
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: 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work 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: $ 17.66/hr.