Claims Customer Care Advocate II

Pgba, Llc

Myrtle Beach, Northern (SC, KY)

Hybrid

USD 36,000 - 52,000

Full time

3 days ago

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Job summary

Pgba, LLC in Myrtle Beach, SC is seeking a FCMB Claims Customer Service Advocate II to respond to routine inquiries and process claims swiftly. You will identify incorrectly processed claims and perform adjustments and reprocessing as needed, while upholding quality standards.

The role emphasizes strong verbal and written communication, customer service excellence, and confidentiality when handling sensitive information.

Qualifications

Two years of customer service experience OR one year of claims or appeals processing experience and one year of customer service experience OR Bachelor's Degree in lieu of work experience.
High School Diploma or equivalent.
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.

Responsibilities

60% Researches and responds to telephone inquiries according to desk procedures, ensuring timeliness, productivity, and quality.
20% Researches and responds to written inquiries and identifies incorrectly processed claims; completes adjustments and/or reprocessing actions; initiates recoupments as necessary.
10% Identifies complaints and inquiries too complex for desk procedures and refers to lead/manager; reports potential fraud and abuse.
10% Completes projects and assignments related to claims processing and customer service functions.