Customer Service Advocate III

Location: Columbia

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* Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed. Research to identify cause and mine ways to prevent and correct such causes. Identifies and reports potential fraud and abuse situations.
* Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity and quality are met. Handles situations that require adaptation of response or extensive research.
* 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. Ensure claims are processed according to established quality and production standards.
* Provide feedback to management regarding customer issues. Maintain accurate records concerning issues. Follow through on complaints until resolved or report to management as needed.
* Maintain knowledge of procedures and policies. Assist with process improvements by recommending improvements in procedures and policies. Assists in training claims customer service representatives.
* ** Required

Education:

*** High School Diploma or equivalent
* ** Required

Work Experience:

*** 3 years of customer service experience, including 1 year of claims or appeals processing experience
** 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 abilities.
* Ability to handle confidential or sensitive information with discretion.
* 3 Years-Customer service or claims processing experience.
* Associate degree-Any Major
* Ability to persuade, negotiate or influence.
* Knowledge of database software.
* Cohere Experience, Genesys and Bluesteps.
* 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
* Education Assistance
* Service Recognition
* National discounts to movies, theaters, zoos, theme parks and more
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