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Customer Service

Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.

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Title: Claims Customer Service Advocate I Location: Columbia, SC, 29229 Duration: 12 months assignment (Contract to Perm) Shift Monday- Friday, 7:30am-4:00pm Duties: <ul><li>Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.</li><li>40% Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.</li><li>40% 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.</li><li>20% Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.</li></ul>

Spectraforce is a leading global services firm that provides a portfolio of Consulting, Staffing and Outsourcing services & solutions to a broad range of clients and industries worldwide. We are headquartered in Raleigh, NC, USA and have offshore global delivery centers at Pune, Chandigarh, and Hyderabad, India. At Spectraforce we have a Philosophy - a Philosophy that excellence is derived through dedicated, focused and innovative work. We also believe that knowledge comes through sharing and growth comes to every organization where people use knowledge in team work. A progressive culture and a world of possibilities is what you see with us.

Spectraforce Technologies Inc

Claims Customer Service Advocate I

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Spectraforce Technologies Inc