Claims Customer Service Advocate

About Mindlance: Founded in 1999 , Mindlance has been ranked as one of the fastest growing US Staffing firms by SIA for 9 consecutive years. We provide workforce solutions to Global 1000 companies in Technology, Engineering, Finance, Clinical Research, Scientific, Digital/Creative/Marketing space. Mindful of the opportunity gap, we provide balanced solutions for both employers and job seekers"”elevating the standards of recruitment practice to a whole new level . Our aim is to make a difference in the lives of job seekers by providing them with opportunities that broaden career horizons and expand skill sets. We take pride in being a strong driver of mindfulness and balance at workplace. EEO: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans." Job Title: Claims Customer Service Advocate Max pay: $15.00 Min Pay: $12:50 Job Category: Customer Service Industry: Insurance Job Location: Columbia, SC Zip Code: 29201 Top 3/5 Skills: ·       Customer Service ·       Inbound/outbound call ·       Data Entry ·       Claims processing Job Description     Customer Service Advocate   Job Responsibilities Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. •45% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines. •45% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards. •10% Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations.   Job Requirements ·        Required Skills and Abilities: 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. ·        Required Software and Other Tools: Microsoft Office. Work Environment: Typical office environment. ·        Required Education: High School Diploma or equivalent ·        Required Work Experience: 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience.

Created: 2025-06-06