Claims Customer Service Advocate II

PGBA,•Myrtle Beach, SC

6d•Onsite

About The Position

The Claims Customer Service Advocate II responds to routine written correspondence and telephone inquiries related to claims or appeals, documents inquiries accurately, and identifies incorrectly processed claims for adjustment and reprocessing. The role also examines and processes claims and non-medical appeals according to business and contract regulations, internal standards, and examining guidelines. It enters claims into the claim system after verifying procedure and diagnosis coding and ensures processing meets quality and production standards. The position is full-time, 40 hours per week, Monday through Friday, and is onsite at 8733 Highway 17 Bypass in Myrtle Beach, South Carolina. Employees must be flexible to work an assigned eight-hour shift scheduled between 9 a.m. and 6 p.m. Training is Monday through Friday, 8 a.m. to 5 p.m., for approximately six to eight weeks. Applicants must be U.S. citizens and able to obtain a security clearance. The position is not eligible for current or future sponsorship. The role identifies complex complaints and inquiries that cannot be resolved using desk procedures and refers them to a lead or manager. It also promptly reports or refers suspected fraud and system errors to the appropriate departments. Because the employer has federal contracts subject to the Service Contract Act, employees must enroll in health insurance benefits; supplemental pay is provided until benefits enrollment 28 days after the hire date.

Requirements

High school diploma or equivalent.
One year of experience, including one year in claims or appeals processing, customer service, or another related support area; alternatively, a bachelor's degree may be used in lieu of work experience.
Good verbal and written communication skills.
Strong customer service skills.
Good spelling, punctuation, and grammar skills.
Basic business math proficiency.
Ability to manage confidential or sensitive information with discretion.
Microsoft Office skills.
U.S. citizenship and ability to obtain a security clearance.
Must enroll in health insurance benefits under Service Contract Act requirements.

Nice To Haves

Associate degree.
Two years of claims processing or call center experience.
Knowledge of word processing, spreadsheet, and database software.

Responsibilities

Respond to written and telephone inquiries about claims or appeals according to desk procedures and meet contract standards for timeliness, productivity, and quality.
Accurately document inquiries.
Identify incorrectly processed claims and complete adjustments and related reprocessing actions according to department guidelines.
Examine and process claims and non-medical appeals in accordance with business and contract regulations, internal standards, and examining guidelines.
Enter claims into the claim system after verifying procedure and diagnosis coding.
Ensure claims are processed according to established quality and production standards.
Identify complex complaints and inquiries that cannot be resolved under desk procedures and refer them to a lead or manager.
Promptly report or refer suspected fraudulent activity and system errors to the appropriate departments.

Benefits

Subsidized health plans, dental and vision coverage.
401(k) retirement savings plan with company match.
Life insurance.
Paid time off (PTO).
On-site cafeterias and fitness centers in major locations.
Wellness program and healthy lifestyle premium discount.
Tuition assistance.
Service recognition.
Employee assistance.
Discounts to movies, theaters, zoos, theme parks, and more.
Supplemental pay until enrollment in health benefits 28 days after the hire date.