FCMB Claims Customer Service Advocate II

PGBA,•Columbia, SC

4d•Onsite

About The Position

The FCMB Claims Customer Service Advocate II responds to routine telephone and written inquiries regarding claims or appeals. The role researches claims, identifies incorrectly processed claims, and completes adjustments and related reprocessing actions, including initiating and documenting requests through completion and initiating recoupments when needed. The advocate also recognizes issues that cannot be resolved under established procedures and refers them to a lead or manager, while identifying and reporting potential fraud and abuse. The position includes completing projects and assignments related to claims processing and customer service. This is a full-time, on-site position at 17 Technology Circle in Columbia, South Carolina, with a Monday-through-Friday schedule of 40 hours per week. Work is scheduled for an eight-hour shift during normal business hours of 8:00 a.m. to 6:00 p.m. Training is on-site, Monday through Friday, from 8:00 a.m. to 5:00 p.m. for approximately 8–10 weeks. Occasional overtime may be necessary, and travel between buildings may be required. Applicants must be U.S. citizens and able to obtain a security clearance. The position is not eligible for sponsorship. As an employee covered by the Service Contract Act, the employee is required to enroll in the company's health insurance; coverage begins on the first day of the month following 28 days of full-time employment. Supplemental pay for health coverage is provided until enrollment is complete.

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.
Proficiency with Microsoft Office.
U.S. citizenship and ability to obtain a security clearance.
Ability to work on-site in Columbia, Monday through Friday, and to travel between buildings as required.

Responsibilities

Research and respond to telephone inquiries according to desk procedures, meeting contract standards for timeliness, productivity, and quality.
Research and respond to written inquiries about claims.
Identify incorrectly processed claims and complete adjustments and/or reprocessing according to department guidelines, including initiating, documenting, and processing requests through completion.
Initiate recoupments as necessary.
Identify complex complaints or inquiries that cannot be resolved using desk procedures and refer them 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.