Claims Customer Service Representative
Location: Columbia, SC
Job Type: Temp to Hire
Company: TRC Talent Solutions
Salary: $16.00 - $17.00 Per Hour
Category: Financial Services
Job Description Apply Now
The Claims Customer Service Representative plays a vital role in delivering high-quality service by addressing routine written and telephone inquiries related to insurance claims. This full-time position is essential for ensuring that claims are processed accurately, efficiently, and in alignment with organizational standards and regulatory requirements. As a Claims Customer Service Representative, you will be responsible for identifying and correcting processing errors, reviewing claims, and managing non-medical appeals. Your role will also include ensuring customer satisfaction through professional communication and problem resolution, which helps maintain the organization's reputation for excellence in customer care.
In this position, you will respond to both written and telephone inquiries, ensuring all interactions are documented accurately and in a timely manner. The Claims Customer Service Representative must be detail-oriented and capable of working within established guidelines to review, adjudicate, and process claims and appeals. This includes verifying the accuracy of claims, entering correct procedure and diagnosis codes, and escalating complex issues to management when necessary. The ability to recognize and report suspected fraudulent activity or system errors is also a key aspect of this role.
As a central point of contact for customers, the Claims Customer Service Representative must possess excellent verbal and written communication skills, proficient spelling and grammar, and a strong command of business math. You will need to demonstrate discretion in handling confidential information and be comfortable navigating multiple computer systems, including Microsoft Office. The position requires either a high school diploma or equivalent with at least one year of experience in claims, appeals processing, or customer service, or a bachelor's degree in lieu of experience.
This opportunity offers a chance to work within a team-oriented environment where adherence to processes and dedication to quality are highly valued. The organization is committed to diversity and inclusion, as reflected in its equal opportunity employment practices. If you are passionate about providing excellent customer service and ensuring the integrity of claims processing, we encourage you to apply for the Claims Customer Service Representative position by clicking the job application button.
Claims Customer Service Representative - Summary- Acts as the first point of contact for customer inquiries related to insurance claims.
- Ensures claims are processed in a timely, accurate, and compliant manner.
- Focuses on delivering high-quality customer service and supports organizational standards.
- Respond to routine written and telephone inquiries in accordance with established procedures, ensuring timely and accurate communication.
- Document all customer interactions and inquiries in the appropriate systems.
- Identify and correct incorrectly processed claims, completing necessary adjustments and reprocessing as guided by departmental protocols.
- Review, adjudicate, and process claims and non-medical appeals per business regulations, contracts, and internal standards.
- Verify procedure and diagnosis coding before entering claims into the system.
- Maintain high standards of quality and productivity in claims processing.
- Escalate complex issues that cannot be resolved through standard procedures to management or a lead as appropriate.
- Identify and promptly report any suspected fraudulent activity or system errors.
- Answer and efficiently manage incoming phone calls.
- Navigate claims and customer service systems effectively to research and resolve customer inquiries.
- Competitive salary commensurate with experience.
- Comprehensive benefits package (details provided during the hiring process).
- Opportunities for advancement and professional growth within the organization.
- High School Diploma or equivalent required; a Bachelor's degree may substitute for experience.
- At least one year of experience in claims or appeals processing, customer service, or a related support role is preferred.
- Strong verbal and written communication skills.
- Excellent customer service abilities.
- Proficient in spelling, grammar, and punctuation.
- Solid business math skills.
- Demonstrated ability to handle confidential and sensitive information with discretion.
- Proficient with Microsoft Office and capable of navigating multiple software systems.
- Ability to pass a background check as required by company policy.
- Detail-oriented and organized with a commitment to accuracy.
- Exceptional communication and interpersonal skills.
- Adaptable and able to handle a fast-paced work environment.
- Comfortable with handling sensitive information responsibly.
- Proactive in identifying and resolving issues.
- Experienced in claims or customer service roles.
- Full-time employment opportunity with a standard Monday to Friday schedule.
- Work environment emphasizes teamwork and adherence to organizational policies.
- Company values diversity, equity, and inclusion in all hiring practices.
- Background check required prior to employment.
- Applicants are encouraged to apply through the job application button for consideration.
TRC Talent Solutions is proud to be an Equal Opportunity Employer (EOE). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.