**Job Description:**
About careerzynith
At careerzynith, we're dedicated to delivering exceptional customer experiences and providing innovative solutions to the ever-evolving healthcare landscape. As a leading provider of health insurance services, we're committed to fostering a culture of excellence, diversity, and inclusion. Our team of passionate professionals is driven by a shared vision of improving the lives of our customers and the communities we serve.
Job Summary
We're seeking an experienced Claims Customer Service Advocate II to join our team at careerzynith. As a key member of our customer service team, you'll play a vital role in ensuring that our customers receive timely, accurate, and courteous responses to their inquiries. This is an exciting opportunity to work in a fast-paced environment, where you'll have the chance to develop your skills, build strong relationships with customers, and contribute to the success of our organization.
Key Responsibilities
As a Claims Customer Service Advocate II, you'll be responsible for:
- Responding to customer inquiries in a timely, accurate, and courteous manner, both over the phone and in writing.
- Handling non-routine situations that require adaptation of response or extensive research, and resolving customer complaints and issues in a fair and professional manner.
- Identifying and processing claims and non-medical appeals according to business/contract regulations, internal standards, and examining guidelines.
- Entering claims into the claim system after verification of correct coding of procedures and diagnosis codes, ensuring that claims are processed according to established quality and production standards.
- Identifying and reporting potential fraud and abuse situations, and referring complex complaints and inquiries to a lead or manager for resolution.
- Providing excellent customer service, ensuring that customers feel valued, heard, and supported throughout the claims process.
What You'll Need
To be successful in this role, you'll need:
- A High School Diploma or equivalent.
- Two years of customer service experience, including one year of claims or appeals processing, or a Bachelor's Degree in lieu of work experience.
- Excellent verbal and written communication skills, with the ability to communicate complex information in a clear and concise manner.
- Strong customer service skills, with a focus on empathy, active listening, and problem-solving.
- Good spelling, punctuation, and grammar skills, with the ability to produce error-free written communication.
- BASIC business math proficiency, with the ability to perform calculations and data entry accurately.
- The ability to handle confidential or sensitive information with discretion and maintain confidentiality.
We Prefer That You Have
While not required, we prefer candidates with:
- One year of call center experience, with a focus on claims processing.
What We Can Do for You
At careerzynith, we're committed to supporting the growth and development of our employees. We offer a range of benefits and perks, including:
- A 401K retirement savings plan with company match.
- Subsidized health plans, dental, and vision coverage.
- Life Insurance.
- Paid Time Off (PTO).
- On-site cafeterias and fitness centers in major locations.
- A wellness program and healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
- Employee Assistance.
- Discounts to movies, theaters, zoos, theme parks, and more.
What to Expect Next
After submitting your application, our recruiting team will review your resume to ensure that you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. We'll then conduct interviews with the most qualified candidates, prioritizing those who demonstrate the preferred qualifications.
Equal Employment Opportunity Statement
careerzynith is an equal opportunity employer, committed to promoting employment opportunities for persons 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. If you need special assistance or an accommodation while seeking employment, please email
[email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request.