Customer Service Advocate II

Spectraforce Technologies
United States, South Carolina, Columbia
Jan 10, 2025
Title: Customer Service Advocate II Location: Columbia, SC, 29229 Duration: 3 Months Time: Monday through Friday with some Saturday ( Overtime)- 8:00 pm- 6 pm Notes: In-person/onsite 6-8 weeks long-Training 8am-4:30pm. Skills: Be able to use a computer-Navigate multiple systems-strong communication skills- Standard Office Equipment skills- Microsoft office. Take on average 30 plus calls a day, assisting members with health questions. Duties: Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. 45% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines. 45% 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. 10% 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 reports potential fraud and abuse situations. Skills: Required Skills and Abilities: 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. Required Software and Other Tools: Microsoft Office. Work Environment: Typical office environment. Required Education: High School Diploma or equivalent Required Work Experience: 1 year of claims processing or customer service experience OR Bachelor's Degree in lieu of work experience. Preferred Education: Associate degree Preferred Work Experience: 3 years-of customer service or call center experience.