Claims Customer Service Advocate II
LocationColumbia, South Carolina
Work modeon-site
Typefull-time
SeniorityMid
Experience2+ yrs
Company size1,001–5,000 people
PostedOct 9, 2026 · 4d ago
Verified live1d ago
At a glanceSummarised by Seekless from the posting.
High School Diploma or equivalent
2 years of customer service experience including 1-year claims or appeals processing OR 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 proficiency
Ability to handle confidential or sensitive information with discretion
Microsoft Office
Skills
Microsoft Office
Summary
Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.
Description
Job Description
Location:
This position is full-time (40 hours/week) Monday - Friday in a typical office environment. Employees are required to work a training schedule of 8:00am to 4:30 pm. You will need to be available to work a 8-hour shift from of 8:00 am to 4:30 pm. It may be necessary, given the business need to work occasional overtime and weekends. This role is located at 4101 Percival Road, Columbia SC.
What You’ll Do:
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Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
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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.
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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 reports potential fraud and abuse situations.
Legal
Sponsorship: This position is not eligible for sponsorship now or in the future.
To Qualify for This Position, You’ll Need:
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Required Education: High School Diploma or equivalent
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Required Work Experience: 2 years of customer service experience including 1-year claims or appeals processing OR Bachelor’s Degree in lieu of work experience.
•
Required Skills and Abilities: Good verbal and written communication skills. Strong customer service skills. Good spelling, punctuation and grammar skills. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion.
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Required Software and Other Tools: Microsoft Office.
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Work Environment: Typical office environment.
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