About this role

Ensure effective customer relations by responding accurately, timely, and courteously to inquiries
Handle non-routine inquiries which may require adaptation of response or extensive research
Identify incorrectly processed claims and processes adjustments according to department guidelines
Examine and process claims and/or non-medical appeals according to business/contract regulations
Enter claims into the claim system after verification of correct coding
Ensure claims are processing according to established quality and production standards
Identify and report potential fraud and abuse situations

High School Diploma or equivalent
2 years of customer service experience including 1 year claims or appeals processing 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

Claims Customer Service Advocate II

Key skills