Engineering Jobs in Ballentine, SC
27 positions found
We provide workforce solutions to Global 1000 companies in Technology, Engineering, Finance, Clinical Research, Scientific, Digital/Creative/Marketing space.
Mindful of the opportunity gap, we provide balanced solutions for both employers and job seekers—elevating the standards of recruitment practice to a whole new level.
Our aim is to make a difference in the lives of job seekers by providing them with opportunities that broaden career horizons and expand skill sets.
We take pride in being a strong driver of mindfulness and balance at workplace.
EEO: “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” Job Title: Customer Service Advocate Job Category: Customer Service Industry: Insurance Job Location: Columbia, SC Zip Code: 29219, 29203, 29229, 29201 Top 3/5 Skills: · Customer Service · Inbound/outbound call · Data Entry Job 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 which 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 processing 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.
Job Requirements · 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.
· Required Software and Other Tools: Microsoft Office.
Work Environment: Typical office environment.
· Required Education: High School Diploma or equivalent · 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.
Duration: 11 Months (Contract to hire)
Location: Columbia, SC
Onsite Requirements: Partially onsite 3 days per week (Tue, Wed, Thurs) and as needed.
Standard work hours: 8:00 AM - 5:00 PM
**Credit check will be required**
Job Summary:
Day to Day:
- A typical day will involve a mix of hands-on coding, architectural design, and research.
- The engineer will spend a significant portion of their time in Python, building and optimizing agentic AI systems using frameworks like LangChain.
- This includes integrating these agents with our backend services and deploying them using CI/CD pipelines into our cloud environment.
- They will also be responsible for researching and testing new agentic models and frameworks, monitoring agent behavior in production, and collaborating with data scientists and business stakeholders to refine requirements and ensure the ethical deployment of AI solutions.
Team: The team is an innovative, collaborative, and empowering environment. We are building the next generation of AI solutions for the enterprise in a fast-paced, project-oriented setting. This is a multi-platformed environment that values creativity, continuous learning, and a customer-focused mindset. The new engineer will play a crucial role in shaping our AI strategy and building foundational tools and accelerators that will drive innovation across the company.
Job Requirements:
**This is a new role to establish a core competency in agentic AI systems. This engineer will be pivotal in designing and deploying advanced AI agents and will build the foundational frameworks for future AI use cases across the organization.**
Required Experience:
Required Software and Tools (Hands on experience required):
- Python
- JavaScript/TypeScript
- AI Tools and Libraries (e.g. LangGraph, LangChain, Deep Agents, Claude Skills, etc.)
- AI Models (e.g. Claude, OpenAI, etc.)
- AI Concepts (e.g. Prompt Engineering, RAG, Agentic AI, etc.)
- Distributed SDLC/DevOps (e.g. github, pipelines, VS Code, testing frameworks, etc.)
- Platforms (Container Platforms, Cloud Platforms, Document Databases, AWS)
- API Design
Python & AI/ML Libraries:
- Deep hands-on experience in Python for AI/ML development.
- Generative AI Development: Proven experience developing Gen AI or AI/ML solutions, from use case conceptualization to production deployment.
- Infrastructure & DevOps: Strong understanding of cloud environments (AWS preferred), LLM hosting, CI/CD pipelines, Docker, and Kubernetes.
- Agentic AI Concepts: Knowledge of agentic/autonomous systems (e.g., reasoning, planning, tool use).
Minimum Required Education: Bachelor's degree-in Computer Science, Information Technology or other job related degree or 4 years relevant experience or Associates degree + 2 years relevant experience
Minimum Required Work Experience: 6years-of application development, systems testing or other job related experience.
Required Technologies: 3-6 years of hands-on experience in Artificial Intelligence, Machine Learning, or related fields.
Nice to have/Preferred skills:
- Proficiency in Python development and FastAPI/Flask frameworks, along with SQL.
- Familiarity with agentic AI frameworks and concepts such as LangChain, LangGraph, AutoGen, Model Context Protocol (MCP), Chain of Thought prompting, knowledge stores, and embeddings.
- Experience developing autonomous agents using cloud-based AI services.
- Experience with prompt engineering techniques and model fine-tuning.
- Strong understanding of reinforcement learning, planning algorithms, and multi-agent systems.
- Experience working across cloud platforms (AWS, Azure, GCP) and deploying AI solutions at scale.
SPM Resources is seeking a Sr. Transportation Construction Inspector with a growing transportation engineering firm in West Columbia, SC. It is a great opportunity to join a growing team looking to add to their dynamic delivery and leadership group. Will be dedicated to a multi-year $2B+ capital improvement design-build project for the SCDOT. Will act as the lead representative coordinating with major heavy civil contractors for the development and replacement of major roads and bridges.
The Sr. Inspector is a senior, proactive leadership role responsible for protecting a major $350M project from quality-driven cost, schedule, and reputational risk. This position is not a compliance-only or box-checking role. The role is expected to actively engage with construction operations, identify quality risks early, and prevent non-conforming work before it occurs, rather than reacting after deficiencies are identified by Quality Assurance (QA) or Owner Verification (OV). This role is designed to prevent quality failures—not document them after the fact.
RESPONSIBILITIES
- Manage, implement, and continuously improve the Contractor’s Quality Control Program in accordance with the approved CQMP.
- Update QC components of the CQMP as required to address changing work activities or identified deficiencies.
- Promote awareness of SCDOT requirements and stakeholder expectations throughout UBJV staff and subcontractors.
- Report to the Joint Venture Management Team on QC performance, trends, and improvement opportunities. Pre-Planning & Activity Planning
- Constructability review of plans for errors or issues.
- Manage and implement the Pre-Planning and Activity Planning process for all major construction activities.
- Schedule, lead, and document Pre-Activity Meetings prior to commencement of work.
- Verify readiness of work activities before release to production. Hold Points & Inspection Authority, schedule, manage, and document all CQMP and Appendix A hold points.
- Verify all prerequisites are satisfied prior to releasing hold points.
- Exercise authority to stop work and reject non-conforming materials or workmanship.
- Coordination with QA and Owner Verification and Coordinate with the Independent Quality Firm (IQF) to ensure proper staffing, coverage, and compliance with the CQMP.
- Provide oversight of QA activities from a contractor QC perspective without interfering with acceptance functions.
- Serve as the primary QC liaison with SCDOT and the Owner Verification Firm. Non-Conformance & Corrective Action and Manage Deficiency Notices (DNs) and Non-Conformance Reports (NCRs) through closure.
- Lead root cause analysis and corrective action development and ensure timely documentation, tracking, and resolution of quality issues.
Field QC Inspections & Reporting
- Perform or oversee QC inspections for self-performed and subcontracted work and ensure inspections and testing are performed by properly certified personnel.
- Review daily QC inspection reports and weekly QC submissions, Environmental & Traffic Control Compliance
- Oversee environmental compliance inspections including SWPPP and erosion control.
- Oversee Maintenance of Traffic and Traffic Control Plan compliance. Documentation & Records Management
- Manage QC document control systems including inspection reports, test results, and material certifications. Ensure records are complete, accurate, and immediately available for audit or review. Materials & Laboratory Coordination
- Coordinate QC laboratory scheduling and testing activities.
- Ensure sampling and testing are performed using AASHTO-accredited laboratories.
- Coordinate QC responsibilities with subcontractors, including paving subcontractor-provided HMA QC.
- The QCM reports directly to the JV Executive Management Team and does not report to the Construction Manager. The QCM has independent authority to stop work, manage and release hold points, reject non-conforming work, and direct corrective actions as required.
REQUIREMENTS (Must have or be able to get certifications)
5–15 years of progressive QC experience in heavy civil highway and bridge construction with experience managing QC programs on large DOT projects.
Demonstrated coordination with QA/IQF and Owner Verification teams.
SCDOT Earthwork and Base Course Technician
Nuclear Gauge HazMat Certification
ACI Concrete Field Testing Technician – Level I (Level II preferred)
Certified Erosion Prevention & Sediment Control Inspector (CEPSCI)
Work Zone Traffic Control Certification
NACE Coating Inspector Level I or SSPC Bridge Coating Inspector Level I (as applicable)
IMSA Traffic Signals Level II and IMSA Fiber Optic Technician Level II (as applicable)
Self-starter and ability to work unsupervised, team player and self-motivated to be successful.
Authorized to legally work in the US.
The Construction Scheduler & BIM Modeler is a hybrid role responsible for integrating schedule development with model-based coordination to improve project predictability, sequencing, and execution. This position supports projects from preconstruction through closeout by combining Critical Path scheduling with BIM coordination, clash detection, and 4D planning.
This role works closely with Project Managers, Superintendents, Preconstruction, and trade partners to ensure projects are delivered on time, fully coordinated, and aligned with company standards for safety, quality, and accountability.
Essential Functions/Job Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, with or without special accommodation.
Key Responsibilities
Scheduling (CPM / Project Controls)
- Develop and maintain baseline CPM schedules during preconstruction
- Build detailed construction schedules including phasing and sequencing
- Identify critical path activities and long-lead procurement items
- Lead schedule coordination meetings with internal teams and subcontractors
- Provide bi-weekly or monthly schedule updates
- Develop recovery schedules when delays occur
- Perform time impact analysis when needed
- Create executive-level schedule reporting dashboards
- Support claims documentation related to schedule impacts
BIM Modeling & Coordination
- Develop and maintain 3D BIM models for coordination and planning
- Perform clash detection and facilitate trade coordination meetings
- Integrate schedule into model for 4D sequencing visualization
- Support quantity takeoffs and model-based estimating
- Produce coordination drawings and assist with shop drawing review
- Maintain BIM standards and naming conventions
- Assist field teams with model access and real-time updates
- Support as-built modeling and closeout documentation
Qualifications
- Bachelor’s degree in construction management, Engineering, Architecture, or related field (preferred)
- 3–5 years of commercial construction experience
- Proficiency in:
- Primavera P6 or Microsoft Project
- Autodesk Revit
- Strong understanding of construction sequencing and field operations
- Ability to read and interpret plans and specifications
- Experience with healthcare or complex commercial coordination preferred
- Excellent communication and analytical skills
This job description outlines the primary and recurring responsibilities of this position. It is not intended to be an exhaustive list of all duties, responsibilities, or tasks that may be required. The individual in this role will regularly perform additional related assignments, special projects, and other duties as directed by company leadership, including the Director of Operations, Preconstruction Manager, and/or other designated supervisors.
South Carolina is an Employment-At-Will state. This job description does not constitute an employment agreement or contract. Management reserves the exclusive right to modify, revise, or update this job description at any time, with or without notice.
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Officer None
What to Expect
Information Professional Officer
More Information
Responsibilities
Information Professional Officers (IPOs) oversee the seamless operation of the global Naval network environment. Their responsibilities include:
- Leading the Naval network warfare missions in developing tactics and procedures to realize tactical, strategic and business advantages afloat and ashore
- Driving interoperability with joint, allied and coalition partners
- Building professional excellence through education, training and certification and milestone qualifications
- Optimizing organizational effectiveness through cutting-edge technologies, knowledge management techniques and a culture of innovation
- Helping to develop and deploy information systems, command and control and space systems
- Serving as a key part of the Information Dominance Corps in its mission to gain a deep understanding of the inner workings of adversaries
- Overseeing the work of Information Systems Technicians - Enlisted Sailors (no degree required) who serve as specialists in information technology
Work Environment
Information Professionals serve in challenging roles of increasing scope and responsibility both afloat and ashore. This could include:
- Serving as part of Battle Group staffs on ships at sea
- Working in C4I/Space/Surveillance on shore tours
- Serving on major Navy and joint staffs
- Serving in command of key communication and surveillance facilities around the globe
Training & Advancement
Those pursuing an Information Professional Officer position are required to attend Officer Candidate School (OCS) in Newport, RI.
Upon completion, candidates typically attend a five-week IP Basic Course of instruction in Pensacola, FL, before or during their initial assignment. IPOs must complete specific qualifications as part of their training during Fleet tours and are expected to pursue advanced education opportunities.
Promotion opportunities are regularly available but competitive and based on performance.
Post-Service Opportunities
Specialized training received and work experience gained in the course of service can lead to valuable credentialing and occupational opportunities in related fields in the civilian sector.
Education Opportunities
Wherever you are in your professional career, the Navy can help ease your financial burdens and advance your career with generous financial assistance and continuing education programs. Beyond professional credentials and certifications, Information Professional Officers can advance their education by:
- Pursuing opportunities at institutions such as Naval Postgraduate School (NPS) or Navy War College (NWC)
- Completing Joint Professional Military Education (JPME) at one of the various service colleges
Postgraduate education is important to the success of the Information Professional. Most IPs will complete a master's degree in C4I, space, information systems, computer science or modeling and simulation.
There's also potential to pursue a graduate certificate, DoW certifications, federal executive fellowships and information assurance scholarships and internships.
Qualifications & Requirements
A degree from a four-year college or university is a minimum educational requirement to become a Commissioned Officer. Candidates seeking an Information Professional Officer position must have a bachelor's degree from a regionally accredited institution in a technical field, preferably in one of following fields: Information Systems, Electrical Engineering, Computer Engineering, Information Operations, Computer Science, Systems Engineering, General Engineering.
All candidates must also be: U.S. citizens, willing to serve worldwide, eligible for a Top Secret/Sensitive Compartmented Information (SCI) security clearance and qualified for sea duty.
General qualifications may vary depending upon whether you're currently serving, whether you've served before or whether you've never served before.
Part-Time Opportunities
There are part-time opportunities available as an Information Professional Officer.
Serving part-time as a Navy Reserve Sailor, your duties will be carried out during your scheduled drilling and training periods. During monthly drilling, Information Professional Officers in the Navy Reserve typically work at a location close to their homes.
For annual training, Information Professional Officers may serve anywhere in the world, whether on a ship at sea or at bases and installations on shore.
Take a moment to learn more about the general roles and responsibilities of Navy Reserve Sailors.
Most of what you do in the Navy Reserve is considered training. The basic Navy Reserve commitment involves training a minimum of one weekend a month (referred to as drilling) and two weeks a year (referred to as Annual Training) - or the equivalent of that.
Information Professional Officers in the Navy Reserve serve in an Officer role. Before receiving the ongoing professional training that comes with this job, initial training requirements must first be met.
For current or former Navy Officers (NAVET): Prior experience satisfies the initial leadership training requirement - so you will not need to go through Officer Training again.
Officers who previously held a commission in another United States Military Service, National Oceanic and Atmospheric Administration, Public Health Service, or United States Coast Guard are exempt from attending ODS or LDO/CWO Academy.
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NOVA Engineering is seeking a Geotechnical Staff Engineer to help manage a wide variety of geotechnical projects based from our Columbia, SC office. Must be willing for travel outside of the Carolina's.
RESPONSIBILITIES
You will be part of a dynamic, growing and energized team – and your role is key to the success of NOVA Engineering. While your job duties may fluctuate day to day, here are some areas we expect to see you excel in:
- Operating and maintaining pressure meter testing equipment
- Laying out borings and test pits with conventional surveying and Global Positioning Systems (GPS)
- Observing and classifying test pits and performing hang auger borings
- Being involved in site seismic testing and Pile Driving Analyzer (PDA) testing
- Classifying samples obtained from drilling operations
- Testing, sampling, and inspecting soil
- Performing routine field and laboratory tests
QUALIFICATIONS
- Bachelor’s degree in Civil Engineering from an ABET-accredited institution, or an equivalent international degree with NCEES credential evaluation, is required.
- E.I.T. is required or ability to obtain within 3 months
- Recent graduates are encouraged to apply
- 1 - 3 years applicable experience is preferred
- Strong communication skills
- Position entails approximately 70% fieldwork and 30% office with occasional travel.
Check out our Perks:
In addition to our welcoming company culture and competitive compensation packages, our employees enjoy the below benefits:
- Comprehensive group medical insurance, including health, dental and vision
- Opportunity for professional growth and advancement
- Certification reimbursement
- Paid time off
- Company–observed paid holidays
- Company paid life insurance for employee, spouse and children
- Company paid short term disability coverage
- Other supplemental benefit offerings including long-term disability, critical illness, accident and identity theft protection
- 401K retirement with company matching of 50% on the first 6% of employee contributions
- Wellness program with incentives
- Employee Assistance Program
NOVA is an Equal Opportunity Employer. All qualified candidates are encouraged to apply. NOVA does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, ancestry, marital status, veteran status or any other characteristic protected by law.
BHE GT&S
JOB DESCRIPTION
BHE GT&S has an exciting opportunity as a Designer 1, Designer 2, or Senior Designer at our Greystone location in Columbia, SC.
RESPONSIBILITIES
- Designs and produces engineering drawings for natural gas and auxiliary facilities.
- Provides technical guidance to engineers and designers, ensuring drawing accuracy, consistency, and adherence to company drafting standards.
- Maintains design consistency across the engineering team by applying established standards, best practices, and quality controls.
- Collaborates with engineering and operations to optimize facility designs and ensure compliance with company specifications, safety requirements, and regulatory standards.
- Maintains and updates standard drawings, facility drawings, and company drafting libraries to support ongoing operations and project needs.
- Operates independently as a selfstarter, completing assignments with minimal supervision while managing priorities effectively.
- Develops complete, timely, and accurate drawing packages for new, expanded, or modified facilities, supporting project objectives and construction schedules.
- Reviews drawings to verify compliance with applicable codes, regulations, and company standards, identifying and resolving discrepancies as needed.
- Evaluates design concepts and performs required engineeringrelated calculations to ensure accuracy and feasibility.
- Manages drawing documentation by organizing and maintaining drawing files, indexes, revision histories, and digital records in accordance with company documentcontrol procedures.
- Completes site visits with engineering and operations teams to ensure drawing accuracy as needed.
QUALIFICATIONS
Designer 1:
0-2 years of AutoCAD experience is required.
Designer 2:
At least 3 years of AutoCAD experience is required.
Sr. Designer:
At least 5 years of AutoCAD experience is required.
All Levels:
- Microstation experience preferred.
- Experience with 3D drawings or modeling.
- Experience with natural gas pipeline and compressor station design.
- Strong math skills, including geometry, trigonometry, and higher mathematics.
- Demonstrated knowledge of mechanical, structural, and electrical engineering design drafting principles.
- Knowledge of national gas codes, Pipeline Safety Regulations, and related codes and standards.
- Excellent planning and organizational skills.
- Ability to work independently.
- Ability to size and design structural steel and reinforced concrete components.
- Ability to develop applications for the CADD system.
- Strong communication skills, and ability to develop rapport with internal and external customers.
- Strong computer skills, including the CADD system.
Education
Associate (Typically two years of related, progressive work experience would be needed for candidates applying for this position who do not possess an associate's degree.)
Preferred Degree
Drafting Design Technology, Engineering Technology, or Mechanical Design Engineering
ABOUT THE TEAM
BHE GT&S is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion or religious creed, age, national origin, ancestry, citizenship status (except as required by law), gender (including gender identity and expression), sex (including pregnancy), sexual orientation, genetic information, physical or mental disability, veteran or military status, familial or parental status, marital status or any other category protected by applicable local, state or U.S. federal law. Employees must be able to perform the essential functions of the position, with or without an accommodation.
JOB INFO
Job Identification 10004481
Job Category Drafting
Posting Date 2026-03-12
Apply Before 2026-04-07T03:59:00+00:00
Job Schedule Full time
Locations 121 Moore Hopkins Ln, Columbia, SC, 29210, US
Relocation Assistance Available for this position dependent upon eligibility requirements
Business Carolina Gas Transmission, LLC
Compensation details: 5
PI1bbb8d7dfb96-3631
We offer competitive pay, training and growth opportunities and a positive work environment.
Main Duties & Responsibilities: Follow proper testing & diagnostic procedures to accurately solve vehicle issues Maintain a clean, safe working environment Perform basic auto care and maintenance tasks such as oil changes, fluid level checks, and tire rotation Perform emissions inspections, safety checks and similar state-regulated vehicle examinations Test the functionality of parts and systems Repair brake and steering systems Diagnose and repair electrical and electronic systems Replace or repair transmissions and fuel components as needed Repair cooling components and systems including air conditioners and engine cooling Complete tire changing, balancing, and installation Prepared to get additional certification as needed Willingness to learn with hands-on training Communicate effectively with Service Advisor about vehicle status and required parts and labor Explain automotive repairs and issues to non-technical employees and customers as needed Uphold the culture and values of our independently owned shop.
Qualifications: Possess a valid state driver’s license for conducting test drives High school diploma or equivalent education, advanced technical education preferred Possession of or ability to obtain ASE certification Strong written and verbal communication skills Analytical skills Coordination and physical stamina Compensation / Salary (Hourly or Annual):Hourly When you join the team at your local, independently owned TechNet Professional Service Center, you’ll be working with a shop that takes pride in what they do.
A local shop in your community, backed by the support of a Nationwide network.
That is just part of what sets a TechNet Automotive Service Center apart from the rest.
Come join #TechNetNation!
We offer competitive pay, training and growth opportunities and a positive work environment.
Main Duties & Responsibilities: Follow proper testing & diagnostic procedures to accurately solve vehicle issues Maintain a clean, safe working environment Perform basic auto care and maintenance tasks such as oil changes, fluid level checks, and tire rotation Perform emissions inspections, safety checks and similar state-regulated vehicle examinations Test the functionality of parts and systems Repair brake and steering systems Diagnose and repair electrical and electronic systems Replace or repair transmissions and fuel components as needed Repair cooling components and systems including air conditioners and engine cooling Complete tire changing, balancing, and installation Prepared to get additional certification as needed Willingness to learn with hands-on training Communicate effectively with Service Advisor about vehicle status and required parts and labor Explain automotive repairs and issues to non-technical employees and customers as needed Uphold the culture and values of our independently owned shop.
Qualifications: Possess a valid state driver’s license for conducting test drives High school diploma or equivalent education, advanced technical education preferred Possession of or ability to obtain ASE certification Strong written and verbal communication skills Analytical skills Coordination and physical stamina Compensation / Salary (Hourly or Annual):Hourly When you join the team at your local, independently owned TechNet Professional Service Center, you’ll be working with a shop that takes pride in what they do.
A local shop in your community, backed by the support of a Nationwide network.
That is just part of what sets a TechNet Automotive Service Center apart from the rest.
Come join #TechNetNation!
We provide workforce solutions to Global 1000 companies in Technology, Engineering, Finance, Clinical Research, Scientific, Digital/Creative/Marketing space.
Mindful of the opportunity gap, we provide balanced solutions for both employers and job seekers—elevating the standards of recruitment practice to a whole new level .
Our aim is to make a difference in the lives of job seekers by providing them with opportunities that broaden career horizons and expand skill sets.
We take pride in being a strong driver of mindfulness and balance at workplace.
EEO: “Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” Job Title: Claims Customer Service Advocate Max pay: $15.00 Min Pay: $12:50 Job Category: Customer Service Industry: Insurance Job Location: Columbia, SC Zip Code: 29201 Top 3/5 Skills: · Customer Service · Inbound/outbound call · Data Entry · Claims processing Job 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 which 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 processing 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.
Job Requirements · 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.
· Required Software and Other Tools: Microsoft Office.
Work Environment: Typical office environment.
· Required Education: High School Diploma or equivalent · 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.