BTG, in partnership with a top ranked healthcare company in Florida, has an immediate need for a Service Advocate.
Requirements of the Service Advocate
- 3-5 years of related work experience or equivalent combination of transferable experience and education
- Experience with processing Medicare claims
- Experience with Quest and Diamond programs.
Benefits of the Service Advocate
- 100% remote
- Medical/ Dental/ Vision
Responsibilities of the Service Advocate
- 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.
If you believe that your skills and experience are a match for this position, please submit your most current resume and a recruiter will be in contact. Resumes can be submitted via email to ************* or by applying online at https://jobs.btginc.com. You may also give us a call at 904-998-9414 to speak to a recruiter.