Claims & Appeals Advocate II

Pgba, Llc; Myrtle Beach (SC); On-site; USD 34,000 - 42,000; Full time

Benefits offered by this job

Subsidized health plans

401K retirement savings with company-m

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Wellness program

Tuition assistance

Service recognition

Employee Assistance

Discounts to movies

Job summary

PGBA, LLC in Myrtle Beach, South Carolina, is seeking a dedicated claims processor to answer routine inquiries, identify incorrectly processed claims, and perform adjustments and reprocessing actions in accordance with contract guidelines.

This full-time, on-site role requires US citizenship for security clearance. The position offers benefits including health plans, 401K with match, PTO, tuition assistance, and wellness programs.

Qualifications

• High School Diploma or equivalent required.
• 1 year claims/appeals processing or related experience OR bachelor’s degree in lieu of work experience.
• Strong verbal and written communication, customer service, and discretion.
• Proficiency with Microsoft Office.

Responsibilities

• Responds to written and/or telephone inquiries according to desk procedures, ensuring timeliness, productivity, and quality.
• Accurately documents inquiries.
• Identifies incorrectly processed claims and processes adjustments and reprocessing actions.
• Examines and processes claims and/or non-medical appeals according to regulations and guidelines.
• Enters claims into the claim system after verification of correct coding.
• Ensures claims are processed according to standards.
• Identifies and reports complex complaints for escalation.
• Reports suspected fraudulent activities and system errors.

Skills

Verbal and written communication

Customer service

Spelling, punctuation, grammar

Business math

Discretion with sensitive information

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

PGBA, LLC in Myrtle Beach, South Carolina, is seeking a dedicated claims processor to answer routine inquiries, identify incorrectly processed claims, and perform adjustments and reprocessing actions in accordance with contract guidelines.

This full-time, on-site role requires US citizenship for security clearance. The position offers benefits including health plans, 401K with match, PTO, tuition assistance, and wellness programs.