Advance your career with Mindlance! We have been connecting talented IT professionals with world-class companies since 1999. Mindlance is here to help you to find the perfect fit with just the right company. Currently, we are seeking an Operational Analyst for an exciting career growth opportunity.
Make your next big career move with the kind of position that will allow you to be genuinely passionate about the work you do! Our recruiters will work closely with you to help you get the edge over the competition. Let Mindlance advocate for you – apply today!
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
Job Title: Claims Customer Service Advocate
Max pay: $15.00
Min Pay: $12:50
Job Category: Customer Service
Industry: Insurance
Job Location: Columbia, SC
Zip Code: 29201
Top 3/5 Skills:
· Customer Service
· Inbound/outbound call
· Data Entry
· Claims processing
Job Responsibilities
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.
Job Requirements
· 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: 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience.