Senior Claims & Appeals Advocate

Southcarolinablues; Columbia (SC); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off (PTO)

Education Assistance

On-site cafeterias and fitness centers

Job summary

National Alliance in Columbia, SC is seeking a Claims Customer Service Advocate III to provide prompt, accurate responses to complex inquiries and adjudicate claims and appeals.

You will review non-routine cases, perform research, and ensure responses meet contractual standards for timeliness and quality while maintaining strict confidentiality in a 40-hour workweek. On-site environment with shift flexibility within 8:00 AM–8:00 PM.

Qualifications

• 3 years of customer service experience, including 1 year of claims or appeals processing OR Bachelor's Degree in lieu of work experience.
• High School Diploma or equivalent
• Good spelling, punctuation, and grammar skills
• Strong customer service skills
• Ability to handle confidential or sensitive information with discretion

Responsibilities

• Review claims or appeals issues referred by claims customer service representatives to determine if desk procedures and guidelines were followed.
• Research underlying causes and determine ways to prevent and correct such causes.
• Examine and process claims and non-medical appeals according to business/contract regulations and guidelines.
• Enter claims into the claim system after verification of correct coding.
• Provide feedback to management regarding customer issues and maintain accurate records.

Skills

Verbal communication

Written communication

Customer service

Business math

Confidential info handling

Education

High School Diploma

Tools

Microsoft Office

Job description

National Alliance in Columbia, SC is seeking a Claims Customer Service Advocate III to provide prompt, accurate responses to complex inquiries and adjudicate claims and appeals.

You will review non-routine cases, perform research, and ensure responses meet contractual standards for timeliness and quality while maintaining strict confidentiality in a 40-hour workweek. On-site environment with shift flexibility within 8:00 AM–8:00 PM.