TALENT Software Services · 1 month ago
Claims Customer Service Advocate I
Myrtle Beach, SC
Full-time
Onsite
New Grad, Entry Level
$17.75/hr - $17.75/hrTALENT Software Services is seeking a Claims Customer Service Advocate I to handle routine inquiries and manage claims processing. The role involves reviewing and adjudicating claims, ensuring adherence to organizational policies, and addressing complex inquiries as needed.
Artificial Intelligence (AI)ConsultingDevOpsHealth CareIT ManagementProject ManagementRecruitingStaffing Agency
Responsibilities
Responsible for responding to routine inquiries
Identifies incorrectly processed claims and completes adjustments and related reprocessing actions
Reviews and adjudicates claims and/or non-medical appeals
Determines whether to return, deny or pay claims following organizational policies and procedures
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
Qualification
Required
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
Company
TALENT Software Services
Talent Software Services is an IT staffing services company of healthcare and government sectors.
Founded in 1987
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Prashanth Upadrashta
Vice President -Global Operations & Delivery
Dave Iacarella
Owner
Recent News
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