FCMB Customer Service Advocate II

PGBA,•Florence, SC

5d•Onsite

About The Position

The Customer Service Advocate II responds to routine correspondence and telephone inquiries about claims and appeals, identifies claims that were processed incorrectly, and completes adjustments and related reprocessing actions. The role proactively resolves members’ and providers’ questions and concerns using computer-based resources. Communication may take place by telephone, written correspondence, web, or walk-in inquiries. The advocate explains benefits, addresses claim concerns, and helps members and providers find doctors through calls, online chats, or emails. Some inquiries require extensive research and collaboration with other departments. Accurate documentation is essential. The advocate is a subject matter expert, may contribute recommendations and process improvements, assist with special projects, and, after mastering the role, may train and share knowledge with new team members. This is a full-time, 40-hour-per-week position, Monday through Friday, at the specified Florence, South Carolina location in a typical office environment. Employees must be flexible to work any eight-hour shift scheduled during normal business hours. Occasional overtime and weekend work may be needed. The position is not eligible for sponsorship now or in the future. As a Service Contract Act employee, the employee must enroll in the company’s health insurance, even if covered elsewhere; supplemental pay for health coverage is provided until enrollment is complete. Coverage begins on the first day of the month following 28 days of full-time employment.

Requirements

High school diploma or equivalent.
Two years of customer service experience; or one year of claims or appeals processing experience and one year of customer service experience; or a bachelor's degree 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 handle confidential or sensitive information with discretion.
Microsoft Office skills.
Flexibility to work any scheduled eight-hour shift during normal business hours.
Ability to work occasional overtime and weekends when business needs require.
Must enroll in the employer's health insurance as an SCA employee.
Must be eligible to work without current or future sponsorship.

Nice To Haves

Strong human relations and organizational skills.
Demonstrated ability to handle high-stress, intense situations and conversations.
Good judgment in handling confidential or sensitive information.
Ability to learn.

Responsibilities

Research and respond to telephone inquiries according to desk procedures and meet contract standards and objectives for timeliness, productivity, and quality.
Research and respond to written inquiries; identify incorrectly processed claims and complete adjustments or reprocessing according to department guidelines, including initiating, documenting, and processing requests to completion.
Initiate recoupments when necessary.
Refer complaints and inquiries that cannot be resolved under desk procedures and guidelines to a lead or manager.
Identify and report potential fraud and abuse situations.
Complete projects and assignments related to claims processing and customer service functions.
Document member and provider questions accurately.
Explain benefits, resolve claim concerns, and help members and providers find doctors.
Collaborate with other departments as needed to research and resolve inquiries.
Contribute recommendations, feedback, and process improvements; assist with special projects.
Train and share knowledge with new team members after mastering the role.

Benefits

Subsidized health plans, with health insurance enrollment required for SCA employees.
Dental coverage.
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.
Education assistance.
Service recognition.
National discounts to movies, theaters, zoos, theme parks, and more.