Healthcare Claims & Appeals Advocate II

Pgba, Llc; Florence (SC); On-site; USD 35,000 - 52,000; Full time

Benefits offered by this job

Health plans

401k

Life Insurance

PTO

Education assistance

Service recognition

Discount programs

Job summary

PGBA, LLC in Florence, SC is seeking a Customer Service Advocate II to handle routine inquiries about claims and appeals and guide members and providers on benefits and finding care. You will use phone, email, and web channels to resolve questions, document details, and collaborate with other departments as needed.

The role emphasizes accuracy, timely responses, and proactive problem solving, with opportunities to train others later.

Qualifications

• High School Diploma or equivalent required.
• 2 years customer service experience OR 1 year claims/appeals processing + 1 year customer service OR Bachelor's degree.
• Strong verbal and written communication.

Responsibilities

• Respond to inquiries via calls, email, chat, or walk-ins.
• Identify incorrectly processed claims and initiate adjustments and reprocessing actions.
• Refer complex issues to a lead or manager for resolution.
• Accurately documenting questions and assisting with special projects.

Skills

Verbal communication

Written communication

Customer service

Attention to detail

Discretion

Microsoft Office

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

PGBA, LLC in Florence, SC is seeking a Customer Service Advocate II to handle routine inquiries about claims and appeals and guide members and providers on benefits and finding care. You will use phone, email, and web channels to resolve questions, document details, and collaborate with other departments as needed.

The role emphasizes accuracy, timely responses, and proactive problem solving, with opportunities to train others later.