Consumer Care Advocate

Consumer Care Advocate

Requirements

• High school diploma or GED required
• Associate’s degree from an accredited college or university preferred
• Professional certification as applicable to line of business preferred
• Two (2) years of administrative and/or customer service experience or equivalent combination of education and experience required
• Excellent oral and written communication skills
• PC literate, including Microsoft Office products
• Strong investigation and organizational skills
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

Responsibilities

• Processes incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving their claims related questions and issues in accordance with designed guidelines and policies
• Communicates claims status and current claim activity with client and appropriate medical contact; responds to inquiries about jurisdiction- and claim-specific issues
• Enters data into claims system(s) and ensures claim files are properly documented and claims coding is correct
• Coordinates claimant address updates or changes with internal departments
• Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations
• Performs other duties as assigned
• Supports the organization’s quality program(s)

Preferred Qualifications

No preferred qualifications provided.