Experienced Claims Customer Service Coordinator – Claims Resolution and Team Leadership
At careerzynith, we're committed to delivering exceptional customer service and innovative solutions to our clients. As a Claims Customer Service Coordinator, you'll play a vital role in leading our claims customer service unit, resolving customer inquiries, and performing initial claims adjudication or non-medical appeals review. If you're passionate about providing top-notch customer service, have a keen eye for detail, and enjoy working in a fast-paced environment, we encourage you to apply for this exciting opportunity.
**About careerzynith**
careerzynith is a leading provider of innovative solutions and services to the insurance industry. With a rich history spanning over seven decades, we've established ourselves as a trusted partner to our clients, delivering outstanding service and expertise. Our commitment to excellence, community involvement, and employee development has earned us an A+ (Superior) rating from A.M. Best, making us the only health insurance company in South Carolina with this prestigious rating.
**Job Summary**
As a Claims Customer Service Coordinator, you'll be responsible for leading our claims customer service unit, resolving customer inquiries, and performing initial claims adjudication or non-medical appeals review. You'll work closely with our team to ensure that all processing expectations and team goals are met. Your exceptional communication skills, attention to detail, and ability to handle complex problems will make you an invaluable asset to our team.
**Key Responsibilities**
- Distribute daily work to employees, track workload and employee performance, and make decisions necessary to ensure all processing expectations and team goals are met.
- Respond accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals, and other technical issues.
- Investigate and initiate resolutions to complex problems.
- Authorize payment recovery, claim payments, or make claim rejections based on documented information and provisions of state or federal law.
- Identify issues with procedures and processes and provide feedback to management on changes and development.
- Train new employees and introduce new material to all employees.
- Develop, update, and maintain procedural manuals.
- Serve as liaison with other departments to address claim, system, and quality issues.
- Perform some testing functions and attend/participate in meetings as needed.
**Qualifications**
- High School Diploma or equivalent required.
- 3 years of customer service experience and 1 year of claims or appeals processing experience, or Bachelor's Degree in lieu of work experience.
- Excellent verbal and written communication skills.
- Strong customer service skills.
- Proficient spelling, punctuation, grammar, and basic business math.
- Ability to handle confidential or sensitive information with discretion.
- Knowledge of claims processing procedures.
- Proficiency in Microsoft Office.
**Work Environment**
- Typical office environment.
- May be required to travel between buildings.
- Occasional overtime may be necessary.
**Comprehensive Benefits Package**
- Subsidized health plans, dental, and vision coverage.
- 401K retirement savings plan with company match.
- Life Insurance.
- Paid Time Off (PTO).
- On-site cafeterias and fitness centers in major locations.
- Wellness program and healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
- Employee Assistance.
- Discounts to movies, theaters, zoos, theme parks, and more.
**Career Growth Opportunities and Learning Benefits**
- careerzynith is committed to employee development and growth. We offer a range of training programs, mentorship opportunities, and career advancement possibilities.
- Our diverse and inclusive workplace fosters a culture of collaboration, innovation, and continuous learning.
- You'll have the opportunity to work with a talented team of professionals, share your ideas, and contribute to the growth and success of our company.
**Veterans Welcome!**
- careerzynith is a strong supporter of our veterans, and many service men and women have joined our ranks.
- We've found that the dedication, work ethic, and job skills that serve well in the military excel in many of our lines of business.
- We proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services, and more.
**How to Apply**
If you're ready to join a diverse company with secure, community roots and an innovative future, apply for this exciting opportunity today! Visit our website to submit your application and join our team of dedicated professionals.
Apply Job!
Apply for this job
**About careerzynith**
careerzynith is a leading provider of innovative solutions and services to the insurance industry. With a rich history spanning over seven decades, we've established ourselves as a trusted partner to our clients, delivering outstanding service and expertise. Our commitment to excellence, community involvement, and employee development has earned us an A+ (Superior) rating from A.M. Best, making us the only health insurance company in South Carolina with this prestigious rating.
**Job Summary**
As a Claims Customer Service Coordinator, you'll be responsible for leading our claims customer service unit, resolving customer inquiries, and performing initial claims adjudication or non-medical appeals review. You'll work closely with our team to ensure that all processing expectations and team goals are met. Your exceptional communication skills, attention to detail, and ability to handle complex problems will make you an invaluable asset to our team.
**Key Responsibilities**
- Distribute daily work to employees, track workload and employee performance, and make decisions necessary to ensure all processing expectations and team goals are met.
- Respond accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals, and other technical issues.
- Investigate and initiate resolutions to complex problems.
- Authorize payment recovery, claim payments, or make claim rejections based on documented information and provisions of state or federal law.
- Identify issues with procedures and processes and provide feedback to management on changes and development.
- Train new employees and introduce new material to all employees.
- Develop, update, and maintain procedural manuals.
- Serve as liaison with other departments to address claim, system, and quality issues.
- Perform some testing functions and attend/participate in meetings as needed.
**Qualifications**
- High School Diploma or equivalent required.
- 3 years of customer service experience and 1 year of claims or appeals processing experience, or Bachelor's Degree in lieu of work experience.
- Excellent verbal and written communication skills.
- Strong customer service skills.
- Proficient spelling, punctuation, grammar, and basic business math.
- Ability to handle confidential or sensitive information with discretion.
- Knowledge of claims processing procedures.
- Proficiency in Microsoft Office.
**Work Environment**
- Typical office environment.
- May be required to travel between buildings.
- Occasional overtime may be necessary.
**Comprehensive Benefits Package**
- Subsidized health plans, dental, and vision coverage.
- 401K retirement savings plan with company match.
- Life Insurance.
- Paid Time Off (PTO).
- On-site cafeterias and fitness centers in major locations.
- Wellness program and healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
- Employee Assistance.
- Discounts to movies, theaters, zoos, theme parks, and more.
**Career Growth Opportunities and Learning Benefits**
- careerzynith is committed to employee development and growth. We offer a range of training programs, mentorship opportunities, and career advancement possibilities.
- Our diverse and inclusive workplace fosters a culture of collaboration, innovation, and continuous learning.
- You'll have the opportunity to work with a talented team of professionals, share your ideas, and contribute to the growth and success of our company.
**Veterans Welcome!**
- careerzynith is a strong supporter of our veterans, and many service men and women have joined our ranks.
- We've found that the dedication, work ethic, and job skills that serve well in the military excel in many of our lines of business.
- We proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services, and more.
**How to Apply**
If you're ready to join a diverse company with secure, community roots and an innovative future, apply for this exciting opportunity today! Visit our website to submit your application and join our team of dedicated professionals.
Apply Job!
Apply for this job