Claims & Appeals Advocate II

Pgba, Llc; Columbia (SC); On-site; USD 36,000 - 60,000; Full time

Benefits offered by this job

Subsidized health plans

401K plan with company match

Paid Time Off

On-site cafeterias

Wellness program

Job summary

PGBA in Columbia, SC is seeking a Claims Customer Service Advocate II to respond to routine inquiries, process claims and appeals, and document interactions. The role involves identifying incorrectly processed claims and performing adjustments and reprocessing actions in a full-time, on-site setting.

The ideal candidate has 1 year of claims/appeals processing or related customer service experience, or a bachelor’s degree in lieu of experience. Requires U.S.

Qualifications

• Good Verbal and Written Communication Skills.
• Strong Customer Service Skills.
• Basic Business Math Proficiency.
• Ability to Manage Confidential or Sensitive Information with Discretion.

Responsibilities

• Responds to written and telephone inquiries per desk procedures.
• Identifies incorrectly processed claims and processes adjustments and reprocessing actions.
• Examines and processes claims and non-medical appeals per regulations and guidelines.
• Enters claims into the system after verifying coding.
• Escalates complex issues to lead or manager when needed.

Skills

Verbal Communication

Written Communication

Customer Service

Spelling & Grammar

Business Math

Discretion with Confidential Info

Education

High School Diploma or Equivalent

Tools

Microsoft Office

Job description

PGBA in Columbia, SC is seeking a Claims Customer Service Advocate II to respond to routine inquiries, process claims and appeals, and document interactions. The role involves identifying incorrectly processed claims and performing adjustments and reprocessing actions in a full-time, on-site setting.

The ideal candidate has 1 year of claims/appeals processing or related customer service experience, or a bachelor’s degree in lieu of experience. Requires U.S.