Service Advocate III Claims QIP

 

Start date: 06/26/2023

Training duration and hours: 6/26/2023 - 9/1/2023, Monday through Friday between 8:00 am to 4:30 pm Eastern Standard Time.

Shift after training: Monday through Friday, between 8:00 AM to 4:30 PM Eastern Standard Time. Room for flexibility towards November.

Hourly Hiring Rate: $18.00

Job Summary
As a Service Advocate III in Claims, you will be required to perform activities related to the processing of claims; providing customer service/inquiry resolution; enrolling, billing and collecting payments from consumers and group accounts; ensuring quality management and improvements in related processes and ensuring customer service needs are met by forecasting, monitoring and adjusting call volumes and staffing requirements. Specifically, the Service Advocate will review and adjudicate claims; determine whether to return, deny or pay claims following policies and procedures; process subrogation, workers' compensation and other claims where third party liability may exist; recover overpayments, and answer inquiries from other internal departments, insurance adjustors, attorneys and members.

The work of a Service Advocate III is guided by instructions, established work routines and/or close supervision. Service Advocates are given some latitude on deciding on how tasks and duties are completed based on changing work situations, work flow, etc. and supervisory approval.

What Will You Be Doing?

• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• 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.

What is Required?

• 0-1 years related work experience.
• High school diploma or GED

What is Preferred?

• Claims processing experience and/or experience in Health Insurance/ Health Care industry.

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, Short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan includes employer contribution and employer match;
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Hourly Pay Range: $18 - $26
Hourly Hiring Rate: $18.00

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

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.