What are the responsibilities and job description for the Customer Service Representative position at Paladin Consulting?
We are seeking a Customer Service Representative to join our team in Columbia, SC! You will ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
Come join a fun team and end enjoy competitive compensation, a great work schedule, and endless opportunities for career growth and advancement within the company, training is provided, and all experience levels are welcome to apply!
Responsibilities :
- 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.
- 45% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations that may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
- 45% 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 processed according to established quality and production standards.
- 10% 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.
Required Skills and Abilities :
