FCMB Customer Service Advocate II at PGBA in Florence, South Carolina

Job description

• Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

Responsibilities

• Researches and responds to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
• Research and respond to written inquiries and identify incorrectly processed claims and completes the adjustment and/or reprocessing action according to department guidelines. This may include initiating, documenting, and processing the request to completion. Initiate recoupments as necessary.
• Identifies complaints and inquiries of a complexity 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.
• Completes projects and/or assignments related to claims processing and customer service functions in the department.

Requirements

• Required Education: High School Diploma or equivalent
• Required Work Experience: 2 years of customer service experience OR 1 year of claims or appeals processing experience and 1 year of customer service 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 proficiency. Ability to handle confidential or sensitive information with discretion.
• Required Software and Other Tools: Microsoft Office.
• Work Environment: Typical office environment.
• Strong human relations and organizational skills, with a demonstrated ability to handle high-stress intense situations and conversations.
• Good judgment and the ability to handle confidential or sensitive information with discretion. Ability to learn.

Skills

Required

• Strong customer service skills
• Basic business math proficiency
• Microsoft Office

Benefits

• We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
• 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