Claims Customer Service Advocate II

PGBA,•Columbia, SC

4d•Onsite

About The Position

The Claims Customer Service Advocate II responds to routine written correspondence and telephone inquiries related to claims or appeals. The role reviews and processes claims and non-medical appeals, identifies incorrectly processed claims, and completes adjustments and reprocessing actions in accordance with department guidelines, contract regulations, and internal standards. The position is full-time, 40 hours per week, onsite at 17 Technology Circle in Columbia, South Carolina, in a typical office environment. Employees must be flexible to work an eight-hour shift scheduled between 9:00 a.m. and 6:00 p.m., Monday through Friday. Training is scheduled Monday through Friday, 8:00 a.m. to 5:00 p.m., for approximately six to eight weeks. The role requires the ability to obtain a security clearance and U.S. citizenship. It is not eligible for current or future sponsorship. As the company holds federal contracts subject to the Service Contract Act, employees must enroll in health insurance benefits; supplemental pay is provided until enrollment in health benefits 28 days after hire.

Requirements

High school diploma or equivalent.
One year of experience, including one year in claims/appeals processing, customer service, or another related support area; a bachelor's degree may be substituted for the 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.
Ability to obtain a security clearance; applicants must be U.S. citizens.

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/or telephone inquiries according to desk procedures while meeting timeliness, productivity, and quality standards.
Accurately document inquiries.
Identify incorrectly processed claims and complete adjustments and reprocessing actions according to department guidelines.
Examine and process claims and/or non-medical appeals according to business and contract regulations, internal standards, and examining guidelines.
Enter claims into the claim system after verifying correct procedure and diagnosis coding.
Ensure claims are processed according to established quality and production standards.
Refer complex complaints and inquiries that cannot be resolved using desk procedures and guidelines to a lead or manager.
Promptly report and/or refer suspected fraudulent activities and system errors to appropriate departments.