Claims Customer Service Advocate I Jobs in South Carolina

Identifies issues with procedures and processes and provides feedback to management on changes and development.

Continuing education funds for additional certifications and certification renewal

You will have to work on site as needed if remote access is granted.

Trains new employees and introduces new material to all employees. Develops, updates, and maintains procedural manuals.

High School Diploma or equivalent

401(k) retirement savings plan with company match

Good verbal and written communication skills

Good spelling, punctuation, and grammar skills

Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines

Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines

Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes

Ensure claims are processing according to established quality and production standards

Excellent verbal and written communication skills.

Strong human relations and organizational skills.

2 years-of customer service or call center experience.

Knowledge of word processing, spreadsheet, and database software.

Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk-in inquiries. Accurately documents inquiries.

Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

Continuing education funds for additional certifications and certification renewal

401(k) retirement savings plan with company match

Subsidized health plans and free vision coverage

Paid annual leave – the longer you work here, the more you earn

On-site cafeterias and fitness centers in major locations

Wellness programs and healthy lifestyle premium discount

Identify and report potential fraud and abuse situations

Complete projects and/or assignments related to claims processing and customer service functions in the department

High School Diploma or equivalent

Ability to follow policies and procedures

Ability to review claims and appeals

Subsidized health plans, dental and vision coverage

Knowledge of the benefit plans for each group.

Bachelor's degree OR 4 years of healthcare experience in customer service, provider network service, membership, billing, and/or claims/appeals processing operations.

2 years of claims/appeals, customer service, or call center experience.

Strong analytical, organizational, and judgement skills.

Strong oral and written communication skills.

Strong spelling, punctuation, and grammar skills.

5 years-of experience processing and adjudicating claims.

Knowledge of mathematical and statistical concepts.

Proficient in word processing and spreadsheet applications. proficient database software skills.

Preferred Software And Other Tools

We Prefer That You Have

Knowledge of the benefit plans for each group

Bachelor's degree or 4 years of healthcare experience in customer service, provider network service, membership, billing, and/or claims/appeals processing operations

2 years of claims/appeals, customer service, or call center experience

Strong analytical, organizational, and judgment skills

Strong oral and written communication skills

Strong spelling, punctuation, and grammar skills

Provide feedback to management regarding customer issues.

Follow through on complaints until resolved or report to management as needed.

Maintain knowledge of procedures and policies.

Good verbal and written communication skills.

Good spelling, punctuation, and grammar skills.

One year of call center experience.

Respond accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals and other technical issues

Identify issues with procedures and processes and provides feedback to management on changes and development

Excellent verbal and written communication skills

Knowledge of claims processing procedures

Investigate and initiate resolutions to complex problems

Authorize payment recovery, claim payments, or makes claim rejections based on documented information and provisions of state or federal law

A proven curriculum providing the knowledge you need to excel.

Our Comprehensive Benefits Package Includes

Best-in-class call center training program.

Peer coach to observe you.

Peer coach for you to observe.

A training lab where you take live calls with a training supervisor close by to answer questions.

One year of medical claims experience.

Knowledge of Microsoft Office applications.

Our Comprehensive Benefits Package Includes

A high school diploma or equivalent.

Self-paced learning and instructor led training.

401(k) retirement savings plan with company match.