Claims Customer Service Advocate II

Duration: 3+ Months (Possible temp to hire) Job Description: Hours/Schedule: 8am – 5pm (occasional mandatory OT may be required based on business needs). Call center is open from 8am - 7pm. Shift may change once training is up. Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Responsibilities: Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. 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 reports potential fraud and abuse situations Experience: 2 years of customer service experience including 1 year claims or appeals processing. Skills: Strong oral and written communication skills. Proficient in spelling, punctuation, and grammar. Strong organizational, analytical, and customer service skills. Ability to handle high stress situations. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion. Ability to learn and operate multiple computer systems effectively and efficiently Education: High School Diploma or equivalent About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com. US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.