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Quality Customer Service Representative - Columbia, SC, United States - US Tech Solutions, Inc.

US Tech Solutions, Inc. Columbia, SC, United States

1 month ago

Full time

Description

Job Title:
Customer Service Representative
Duration: 12 months contract(Possible Extension)
Training 6 weeks onsite. No option for Remote.

Medical background, office experience, customer service, previous call center experience Candidate would handle provider service calls, responding and answering any questions providers may have.
Must have previous customer service and call center experience. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.
Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in 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 reports potential fraud and abuse situations.

2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience
Strong customer service skills. Ability to handle confidential or sensitive information with discretion.

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