The role of a Service Advocate is focused on servicing current or potential customers, providers, agents, brokers, benefit administrators or consultants. The major accountability of this role is customer, provider, agent, broker, benefit administrator or consultant satisfaction.
- The essential functions listed represent the major duties of this role, additional duties may be assigned.
- Provides customer service to plan members and/or providers by answering benefit questions, researching and resolving issues and inquiries and ensuring members and providers understand the Company’s products and services.
- Acts as a liaison between hospitals, physicians, health plans, vendors, patients or referral sources.
- Initiates and manages clinical referrals for members.
- Verifies insurance coverage and obtains authorizations if needed.
- Enters referrals and documents communications, actions and other data in departmental systems.
- Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient certification and/or prior authorization requests.
- Refers cases requiring clinical review to appropriate clinical professionals.
- May provide guidance and expertise to less experienced Service Advocates.
- Call center position supporting BCBSF’s Pre Service Medical Review Team
• Assist providers with the entry and update of requests for medical clearances
• Research, coordinate and resolve inquiries and claims exceptions
• Coordinate with other Provider Service areas to identify formal education opportunities
• Identify, document and monitor process improvements
• Moderate to heavy keying required
Required Work Experience
• 2+ years’ experience in health insurance, provider’s office (handling medical coding, filing insurance claims or referrals) or a managed healthcare telephone service center
• Experience working with healthcare products including researching and resolving provider inquiries and working with provider contracts and networks
• Experience working with medical terminology, CPT-4 coding, ICD-9 coding and claims adjudication inquiry resolution processes and procedures
• Experience working with MS Word and Excel
• Experience with Legacy systems
• Successful performance on job related assessments
• Requires 9:30 a.m. to 6:00 p.m. shift coverage
High School Diploma or equivalent
Business Specific Criteria (preferred skills):
• Experience working with BCBSF healthcare products
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 Employer/Protected Veteran/Disabled.