Call center Representative - US Tech Solutions, Inc.
columbia, SC
About the Job
Job Description:
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.
Experience:
1 year of experience in a claims/appeals processing, customer service
Skills:
High School Diploma or equivalent Required
- Training is 8:00-4:30 Monday- Friday, after training, trainees can be assigned any 8-hr. shift between 8:00am-8:00pm. The expectation is no time missed during training.
- Onsite training lasts about 6-8 weeks with the option to work remote after training, based on performance. If they will be moved to remote, they should live close enough to report to the office if they experience any outages in their home or asked to return onsite to our Percival office. Client will provide equipment.
- There is only ONE start date i.e. April 1st. There will be no alternate start date for the req.
- Data entry experience, insurance/medical office experience, Microsoft Office experience and the ability to adapt to changes as they arise.
- We would like the candidate to have the following soft skills: good communication skills, ability to adapt, multitasking skills, organized, receptive feedback and follows company policies.
- Our Team is dedicated to training our future Customer Service Advocates to be professional and knowledgeable.
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.
Experience:
1 year of experience in a claims/appeals processing, customer service
Skills:
- 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.
High School Diploma or equivalent Required
Source : US Tech Solutions, Inc.