Rewritten Job Title:
Experienced Claims Customer Service Advocate III – Complex Claims Resolution and Customer Experience Expert
**Rewritten Job Description:**
Join careerzynith as an Experienced Claims Customer Service Advocate III – Complex Claims Resolution and Customer Experience Expert
At careerzynith, we're committed to delivering exceptional customer experiences and resolving complex claims with precision and care. As an Experienced Claims Customer Service Advocate III, you'll play a vital role in our mission to provide unparalleled service to our customers. If you're passionate about delivering outstanding customer experiences, resolving complex claims, and working in a dynamic team environment, we invite you to join our team!
About careerzynith
careerzynith is a leading health insurance company with a rich history of serving the South Carolina community for over seven decades. With a strong commitment to excellence, innovation, and customer satisfaction, we've earned an A+ (Superior) rating from A.M. Best, making us the only health insurance company in South Carolina with this prestigious rating. Our diverse family of subsidiary companies allows us to build on a variety of business strengths, and we're proud to be one of the nation's leading administrators of government contracts.
Why Join careerzynith?
Be part of a dynamic team that values customer satisfaction and excellence
Work in a fast-paced, innovative environment that encourages growth and development
Enjoy a comprehensive benefits package, including 401(k) retirement savings plan, subsidized health plans, and free vision coverage
Take advantage of tuition assistance, continuing education funds, and service recognition programs
Be part of a company that values diversity, equity, and inclusion, and is committed to creating a workplace that's welcoming and inclusive for all employees
Job Summary
We're seeking an Experienced Claims Customer Service Advocate III to join our team in a full-time, onsite role at our Percival Road or Greenville location, with potential work-from-home opportunities. As a Claims Customer Service Advocate III, you'll provide prompt, accurate, and courteous responses to complex customer inquiries, resolve claims and appeals, and ensure that contract standards and objectives for timeliness, productivity, and quality are met.
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 determine 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
Maintains accurate records concerning issues
Follows through on complaints until resolved or reports to management as needed
Maintains knowledge of procedures and policies
Assists with process improvements by recommending improvements in procedures and policies
Assists in training claims customer service representatives
Qualifications:
To qualify for this position, you'll need:
A High School Diploma or equivalent
3 years of customer service experience, including 1 year of claims or appeals processing experience, or a Bachelor's Degree in lieu of work experience
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
Microsoft Office skills
Preferred Qualifications:
We prefer candidates with:
A Bachelor's degree in Business Administration, Healthcare Administration, or other job-related field
ADGS/Engage One system knowledge
What We Can Do for You:
At careerzynith, we're committed to providing a comprehensive benefits package that supports your physical, emotional, and financial well-being. Our benefits include:
401(k) retirement savings plan with company match
Subsidized health plans and free vision coverage
Life insurance
Paid annual leave – the longer you work here, the more you earn
Nine paid holidays
On-site cafeterias and fitness centers in major locations
Wellness programs and healthy lifestyle premium discount
Tuition assistance
Service recognition
Incentive Plan
Merit Plan
Continuing education funds for additional certifications and certification renewal
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
Salary Range Information:
The salary range for this position is $14.92 - $27.50 per hour, with a midpoint of $21.21 per hour.
Equal Employment Opportunity Statement:
careerzynith and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information, or any other legally protected status. We're committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request.
Join Our Team:
If you're ready to join a dynamic team that values customer satisfaction, excellence, and innovation, apply for this position now! We look forward to welcoming you to the careerzynith family!
Apply Job!
Apply for this job
**Rewritten Job Description:**
Join careerzynith as an Experienced Claims Customer Service Advocate III – Complex Claims Resolution and Customer Experience Expert
At careerzynith, we're committed to delivering exceptional customer experiences and resolving complex claims with precision and care. As an Experienced Claims Customer Service Advocate III, you'll play a vital role in our mission to provide unparalleled service to our customers. If you're passionate about delivering outstanding customer experiences, resolving complex claims, and working in a dynamic team environment, we invite you to join our team!
About careerzynith
careerzynith is a leading health insurance company with a rich history of serving the South Carolina community for over seven decades. With a strong commitment to excellence, innovation, and customer satisfaction, we've earned an A+ (Superior) rating from A.M. Best, making us the only health insurance company in South Carolina with this prestigious rating. Our diverse family of subsidiary companies allows us to build on a variety of business strengths, and we're proud to be one of the nation's leading administrators of government contracts.
Why Join careerzynith?
Be part of a dynamic team that values customer satisfaction and excellence
Work in a fast-paced, innovative environment that encourages growth and development
Enjoy a comprehensive benefits package, including 401(k) retirement savings plan, subsidized health plans, and free vision coverage
Take advantage of tuition assistance, continuing education funds, and service recognition programs
Be part of a company that values diversity, equity, and inclusion, and is committed to creating a workplace that's welcoming and inclusive for all employees
Job Summary
We're seeking an Experienced Claims Customer Service Advocate III to join our team in a full-time, onsite role at our Percival Road or Greenville location, with potential work-from-home opportunities. As a Claims Customer Service Advocate III, you'll provide prompt, accurate, and courteous responses to complex customer inquiries, resolve claims and appeals, and ensure that contract standards and objectives for timeliness, productivity, and quality are met.
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 determine 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
Maintains accurate records concerning issues
Follows through on complaints until resolved or reports to management as needed
Maintains knowledge of procedures and policies
Assists with process improvements by recommending improvements in procedures and policies
Assists in training claims customer service representatives
Qualifications:
To qualify for this position, you'll need:
A High School Diploma or equivalent
3 years of customer service experience, including 1 year of claims or appeals processing experience, or a Bachelor's Degree in lieu of work experience
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
Microsoft Office skills
Preferred Qualifications:
We prefer candidates with:
A Bachelor's degree in Business Administration, Healthcare Administration, or other job-related field
ADGS/Engage One system knowledge
What We Can Do for You:
At careerzynith, we're committed to providing a comprehensive benefits package that supports your physical, emotional, and financial well-being. Our benefits include:
401(k) retirement savings plan with company match
Subsidized health plans and free vision coverage
Life insurance
Paid annual leave – the longer you work here, the more you earn
Nine paid holidays
On-site cafeterias and fitness centers in major locations
Wellness programs and healthy lifestyle premium discount
Tuition assistance
Service recognition
Incentive Plan
Merit Plan
Continuing education funds for additional certifications and certification renewal
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
Salary Range Information:
The salary range for this position is $14.92 - $27.50 per hour, with a midpoint of $21.21 per hour.
Equal Employment Opportunity Statement:
careerzynith and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information, or any other legally protected status. We're committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request.
Join Our Team:
If you're ready to join a dynamic team that values customer satisfaction, excellence, and innovation, apply for this position now! We look forward to welcoming you to the careerzynith family!
Apply Job!
Apply for this job