Customer Service Advocate II

Customer Service Representative

Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.

Location: This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility work any our 8-hour shift scheduled during hours of 8am - 6pm due to contractual obligations. Training will be Monday Friday 8:00 AM 5:00 PM for approximately 6-8 weeks. This role is located on site at 17 Technology Circle, Columbia SC.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You'll Do:

• 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.

To Qualify for This Position, You'll Need the Following:

• Required Education: A High School Diploma or equivalent
• Required Work Experience: 1-year of experience including 1-year claims/appeals processing, customer service, or other related support area OR bachelor's degree in lieu of work experience.
• 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 Manage Confidential or Sensitive Information with Discretion. Required Software and Tools: Microsoft Office.

Our comprehensive benefits package includes the following: Subsidized health plans, dental and vision coverage, 401K retirement savings plan with company match, Life Insurance, Paid Time Off (PTO), On-site cafeterias and fitness centers in major locations, Wellness program and healthy lifestyle premium discount, Tuition assistance, Service recognition, Employee Assistance, Discounts to movies, theaters, zoos, theme parks and more.