The role of Service Advocate is focused on servicing current or potential customers (which are defined as members, providers, agents, brokers, benefit administrators or benefits consultants). Incumbents resolve questions and issues, help the Company’s customers utilize products, tools and services and directly contribute to customer satisfaction and retention.
- The essential functions listed represent the major duties of this role, additional duties may be assigned.
- The work of a Service Advocate III is guided by instructions, established work routines and/or close supervision. Incumbents are given some latitude on deciding on how tasks and duties are completed based on changing work situations, work flow, etc. and supervisory approval. Incumbents perform semi-routine duties within established systems and procedures. Example job duties may include:
- Review and adjudicate high risk claims.
- Process credit listing functions, aged listings and held claims.
- Process adjustments by working with ambulance services, inpatient facility services, and others.
- Determine whether to return, deny or pay claims following contract benefit and organizational processing guidelines.
- Perform additional research to develop claims; includes contacting providers or members.
- Provide customer service and education to plan members and providers by answering more complex questions regarding insurance claims and policies, resolving issues and ensuring customers understand the Company’s products, services and processes. Calls are predominantly routine, but may require deviation from standard screens, scripts and procedures.
- Perform research to respond to inquiries and interpret policy provisions to determine most effective response.
- Use computerized systems for tracking, information gathering and troubleshooting.
- Actively seek, identify and implement process improvement opportunities.
Required Work Experience
0-1 year of related work experience or equivalent combination of transferable experience and education. Experience Details:
High school diploma or GED
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.