FCMB Claims Customer Service Advocate II

PGBA, • Myrtle Beach, SC

3d • Onsite

About The Position

Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. This position is full time (40 hours/week) Monday-Friday from 8:00am – 5:30pm EST and will be on-site in Myrtle Beach, SC. This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

Requirements

• High School Diploma or equivalent
• One year of experience in a claims/appeals processing, customer service, or other related support area OR 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 and Abilities: Answers phones
• Follows policies and procedures
• Navigates systems
• Processes claims
• Researches inquiries
• Reviews claims and appeals
• Must be a U.S. Citizen to obtain a security clearance.

Responsibilities

• Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
• Accurately documents inquiries.
• Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
• 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.
• 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 promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

Benefits

• 401(k) retirement savings plan with company match
• Subsidized health plans
• Free vision coverage
• Life insurance
• Paid annual leave
• Nine paid holidays
• On-site cafeterias
• Fitness centers
• Wellness programs
• Healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Incentive Plan
• Merit Plan
• Continuing education funds for additional certifications and certification renewal

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED