FCMB Claims Customer Service Advocate II

About This Role

Respond to routine correspondence and telephone inquiries regarding claims and appeals, identifying and correcting incorrectly processed claims. This role requires working with significant contract standards and quality objectives.

Responsibilities

• Respond to written and/or telephone inquiries according to desk procedures, ensuring contract standards for timeliness, productivity, and quality are met
• Accurately document inquiries in the system
• Identify incorrectly processed claims and complete adjustments and reprocessing actions per department guidelines
• Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines
• Enter claims into the claim system after verifying correct coding of procedures and diagnosis codes
• Ensure claims are processed according to established quality and production standards
• Identify complex complaints and inquiries not resolvable via desk procedures and refer them to a lead or manager
• Promptly report and/or refer suspected fraudulent activities and system errors to appropriate departments

Requirements

• High School Diploma or equivalent
• 1 year of experience in claims/appeals processing, customer service, or related support area (or Bachelor's degree)
• Good Verbal and Written Communication Skills
• Strong Customer Service Skills
• Good Spelling, Punctuation and Grammar Skills
• Basic Business Math Proficiency
• Ability to Manage Confidential or Sensitive Information with Discretion
• Proficiency with Microsoft Office

Qualifications

• High School Diploma or equivalent
• 1 year of experience in claims/appeals processing, customer service, or related support area, OR a bachelor's degree in lieu of work experience

Nice to Have

• Associate degree
• 2 years of claims processing or call center experience
• Knowledge of word processing, spreadsheet, and database software

Skills

* Required skills

Benefits