Experienced Claims Customer Service Advocate III – Complex Claims Resolution and Customer Support Specialist at blithequark

Introduction to blithequark At blithequark, we pride ourselves on being a leader in our industry, with a strong commitment to providing exceptional customer service and support. As a Claims Customer Service Advocate III, you will play a vital role in our team, responsible for resolving complex customer inquiries and claims in a timely and professional manner. With a focus on delivering outstanding service to our customers, we are seeking an experienced and skilled individual to join our team and contribute to our mission of excellence. Job Summary The Claims Customer Service Advocate III position is a full-time role, working 40 hours per week, Monday through Friday, in a typical office environment. As a key member of our customer service team, you will be responsible for providing prompt, accurate, thorough, and courteous responses to complex customer inquiries, reviewing and adjudicating complex or specialty claims and/or non-medical appeals, and determining whether to return, deny, or pay claims following organizational policies and procedures. Key Responsibilities Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed Researches to identify underlying causes and determines ways to prevent and correct such causes Identifies and reports potential fraud and abuse situations Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity, and quality are met Handles situations that require adaptation of response or extensive research 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 Provides feedback to management regarding customer issues and maintains accurate records concerning issues Follows through on complaints until resolved or reports to management as needed Maintains knowledge of procedures and policies and assists with process improvements by recommending improvements in procedures and policies Assists in training claims customer service representatives Qualifications and Requirements To be successful in this role, you will need to possess the following qualifications and skills: Essential Qualifications High School Diploma or equivalent 3 years of customer service experience, including 1 year of claims or appeals processing experience, OR Bachelor's Degree in lieu of work experience Knowledge of Microsoft Office Good verbal and written communication skills Strong customer service skills Good spelling, punctuation, and grammar skills Basic business math abilities Ability to handle confidential or sensitive information with discretion Preferred Qualifications Experience working in a claims or customer service environment Knowledge of claims processing and adjudication procedures Experience with claims software and systems Strong analytical and problem-solving skills Ability to work in a fast-paced environment and prioritize tasks effectively Career Growth and Development Opportunities At blithequark, we are committed to providing our employees with opportunities for growth and development. As a Claims Customer Service Advocate III, you will have access to training and development programs, as well as opportunities for advancement within the company. We believe in investing in our employees and providing them with the tools and resources they need to succeed in their careers. Work Environment and Company Culture Our company culture is built on a foundation of respect, integrity, and excellence. We believe in creating a work environment that is inclusive, supportive, and empowering, where our employees can thrive and grow. We offer a range of benefits and perks, including subsidized health plans, dental and vision coverage, 401k retirement savings plan with company match, life insurance, paid time off, on-site cafeterias and fitness centers, and education assistance. Compensation and Benefits We offer a competitive compensation package, including a salary range that is commensurate with experience. Our benefits package includes subsidized health plans, dental and vision coverage, 401k retirement savings plan with company match, life insurance, paid time off, on-site cafeterias and fitness centers, and education assistance. We also offer a range of perks, including national discounts to movies, theaters, zoos, theme parks, and more. Conclusion If you are a motivated and experienced customer service professional looking for a new challenge, we encourage you to apply for the Claims Customer Service Advocate III position at blithequark. With a strong commitment to providing exceptional customer service and support, we are seeking an individual who shares our values and is passionate about delivering outstanding results. Apply today to join our team and take the first step towards a rewarding and challenging career with blithequark. How to Apply To apply for this position, please submit your application through our website. We look forward to receiving your application and discussing this opportunity further with you. Equal Employment Opportunity Statement blithequark is an equal opportunity employer, committed to providing a work environment that is free from discrimination and harassment. We welcome applications from qualified candidates of all backgrounds and perspectives. Apply for this job