Claims Customer Service Representative

Job Title:Claims Customer Care Rep

Location: Columbia, SC 29229

Job Duration: 4 Months (Contract to Perm)

Hours/Schedule: Monday-Friday, 8:30 AM - 4:30 PM

Job Description:

• Under direct supervision, the Quality Control Auditor performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, Customer Service/call centre, workflow, processing support systems, procedures, and documentation. The role involves identifying problems, analysing cause and effect, and making recommendations for improvements.

Requirements:

• Previous industry experience in claims, Customer Service, or provider service calls is required.
• Good communication skills.
• Ability to multitask and switch tasks with accuracy.

Key Responsibilities:

• Responsibilities include claims investigation, workflow activities, and audits.
• This role offers an opportunity to contribute to quality assurance processes and make recommendations for improvements in departmental operations.
• Perform routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed.
• Recognize and document any potential fraud and abuse situations.
• Provide one-on-one guidance to new hires upon completion of initial training.
• Provide necessary feedback or coaching to operations and training areas on errors assessed so that additional training can be initiated as needed.
• Compile data and generate reports for operations areas on quality performance.
• Identify areas of weakness and communicate recommendations on changes and improvements to training materials.
• Document findings of analysis and prepare recommendations for the implementation of new systems, procedures, or organizational changes.
• Assist with training documentation and development of new processes and procedures.
• Remain current with all guidelines, work instructions, etc.

Job Type: Full-time

Pay: $14.00 - $15.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Work setting:

• In-person

Ability to Relocate:

• Columbia, SC 29229: Relocate before starting work (Required)

Work Location: In person