lancesoftMyrtle Beach, SC
Claims Customer Service Advocate II
$17.75/hour
Apply →Claims Customer Service Advocate II
Claims Customer Service Advocate II
lancesoftMyrtle Beach, SC
17 days ago
$17.75/hour
Customer Service RepresentativesInsurance Claims and Policy Processing ClerksClaims Adjusters, Examiners, and Investigators
Claims AdjustingAll Other Insurance Related ActivitiesPharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
Apply for this role →SCA PositionsSCA positions at $17.75/hour pay-rate + $5.36 H&W = $23.11 Onsite position. Training will be six weeks onsite. Hours are 8am – 5pm (occasional mandatory OT may be required based on business needs). Call center is open from 8am - 7pm. Shift may change once training is up. Potential for conversion to FTE. Supporting Tricare East. Interviews will be scheduled for in-person/onsite.
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.
- 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
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.
Also on the board Same function, level within a rung
Level
Mid
Salary
$17.75/hour
Location
Myrtle Beach, SC
Occupation
Customer Service Representatives
Industry
Claims Adjusting
Posted
17 days ago