Technical Developer/Support Specialist providing technical and developer support for Niagara based hardware and software solutions. Experienced in troubleshooting automation software and assisting developers.
BC
Onsite Claims Customer Service Advocate II
Posted last week
About the role
- Claims Customer Service Advocate responsible for responding to customer inquiries and adjudicating claims. Also handles appeals and resolves complex inquiries based on organizational policies.
Responsibilities
- Responsible for responding to customer inquiries.
- Perform research as needed to resolve inquiries.
- Review and adjudicate claims and/or non-medical appeals.
- Determine whether to return, deny or pay claims following organizational policies and procedures.
- Ensure effective customer relations by responding accurately, timely, and courteously to inquiries.
- Handle situations which may require adaptation of response or extensive research.
- Identify incorrectly processed claims and process adjustments and reprocessing actions.
- Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
- Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.
- Ensure claims are processing according to established quality and production standards.
- Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution.
- Identify and report potential fraud and abuse situations.
Requirements
- High School Diploma or equivalent
- 2 years of customer service experience including 1 year of claims or appeals processing experience OR 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
- Microsoft office
Benefits
- 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
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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