Experienced Claims Customer Service Advocate III – Complex Claims Resolution and Customer Experience Expert

Are you a customer service professional with a passion for delivering exceptional experiences and resolving complex claims? Do you thrive in a fast-paced environment where no two days are the same? If so, we invite you to join the esteemed team at blithequark as an Experienced Claims Customer Service Advocate III. In this pivotal role, you will be the voice of our customers, providing empathetic and informed support to resolve intricate claims and appeals. Your expertise will be invaluable in ensuring that our customers receive the highest level of service, while also upholding the integrity of our claims process.

About blithequark

At blithequark, we are committed to delivering innovative solutions that transform the lives of our customers. With a rich history spanning over seven decades, we have established ourselves as a leader in the health insurance industry, with a strong presence in South Carolina and beyond. Our A.M. Best rating of A+ (Superior) is a testament to our financial stability and commitment to excellence. We are proud to be a diverse and inclusive workplace, where employees from all backgrounds can grow, develop, and contribute their unique skills to our growth.

Job Summary

As an Experienced Claims Customer Service Advocate III, you will be responsible for providing exceptional customer service to resolve complex claims and appeals. Your expertise will be essential in ensuring that our customers receive timely, accurate, and courteous responses to their inquiries. You will work closely with our claims team to research and resolve claims, while also identifying opportunities for process improvements and recommending changes to our procedures and policies.

Key Responsibilities

* Reviews complex claims and 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
• 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

Essential Qualifications

* High School Diploma or equivalent

• 3 years of customer service experience, including 1 year of claims or appeals processing experience
• 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 appeals processing environment

• Knowledge of health insurance regulations and policies
• Experience with claims management software
• Strong analytical and problem-solving skills
• Ability to work in a fast-paced environment with multiple priorities

Skills and Competencies

* Excellent communication and interpersonal skills

• Strong analytical and problem-solving skills
• Ability to work in a fast-paced environment with multiple priorities
• Strong attention to detail and accuracy
• Ability to handle confidential or sensitive information with discretion
• Strong customer service skills
• Ability to work independently and as part of a team

Career Growth Opportunities and Learning Benefits

At blithequark, we are committed to the growth and development of our employees. We offer a range of training programs and opportunities for advancement, including:

• On-the-job training and mentorship
• Formal training programs and workshops
• Opportunities for advancement and career growth
• Access to industry-leading tools and technologies
• Collaborative and supportive work environment

Work Environment and Company Culture

Our office is located at 17 Technology Circle, Columbia, SC 29203, and we offer a range of benefits and perks, including:

• Subsidized health plans, dental, and vision coverage
• 401(k) retirement savings plan with company match
• Life insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks, and more

Compensation, Perks, and Benefits

We offer a competitive salary and benefits package, including:

• Salary range: $60,000 - $80,000 per year
• Bonus structure: Eligible for annual bonus based on performance
• Benefits: Subsidized health plans, dental, and vision coverage; 401(k) retirement savings plan with company match; life insurance; paid Time Off (PTO); on-site cafeterias and fitness centers in major locations; education assistance; service recognition; national discounts to movies, theaters, zoos, theme parks, and more

How to Apply

If you are a motivated and customer-focused professional looking for a challenging and rewarding role, we invite you to apply for the Experienced Claims Customer Service Advocate III position at blithequark. Please submit your resume and cover letter to our online application system. We look forward to hearing from you! Apply to this job

Equal Employment Opportunity Statement

blithequark is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating a workplace that is inclusive and respectful of all employees, 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 participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. Apply for this job