Customer Service Advocate II

PGBA,•Columbia, SC

1d•Onsite

About The Position

Provides prompt, accurate, thorough, and courteous responses to customer inquiries, including non-routine inquiries that may require deviation from standard screens, scripts, and procedures. Researches issues as needed to resolve them. Responds to written and telephone inquiries in line with desk procedures and contract standards for timeliness, productivity, and quality, and documents inquiries accurately. Identifies incorrectly processed claims and makes adjustments or reprocessing actions according to department guidelines. Examines and processes claims and non-medical appeals under applicable business and contract regulations, internal standards, and examining guidelines. Enters claims into the claim system after verifying procedure and diagnosis coding, and ensures processing meets quality and production standards. Refers complex complaints and inquiries that cannot be resolved using desk procedures to a lead or manager, and reports suspected fraud or system errors to the appropriate departments. This is a full-time, 40-hour-per-week onsite role at 4101 Percival Road in Columbia, South Carolina. The schedule is Monday through Friday, with an eight-hour shift during normal business hours of 8:00 a.m. to 5:00 p.m. Occasional overtime may be necessary, and travel between buildings may be required. Training is onsite, Monday through Friday, 8:00 a.m. to 5:00 p.m., for approximately 8–10 weeks. This position is not eligible for sponsorship now or in the future.

Requirements

High school diploma or equivalent.
One year of experience in claims or appeals processing, customer service, or another related support area; a bachelor's degree may be substituted for 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 proficiency.

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 customer inquiries according to desk procedures and contract standards for timeliness, productivity, and quality.
Accurately document customer inquiries.
Research inquiries and take steps to resolve them, including non-routine issues that may require deviation from standard procedures.
Identify incorrectly processed claims and process adjustments and reprocessing actions according to department guidelines.
Examine and process claims and 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 meet established quality and production standards.
Refer complex complaints and inquiries that cannot be resolved through desk procedures to a lead or manager.
Promptly report or refer suspected fraudulent activities and system errors to the appropriate departments.