Job Description

One of our clients on the Southside area of Jacksonville, FL has an immediate need for a Universal Service Advocate. The perfect candidate will have the following skills and experience:
This position services potential, new and existing customers, which are defined as individual members, group members, business decision makers and agents. Handles all inquiries related to the following: the Federal Market Place, CMS, ACA Compliance rules, individual enrollment, billing, reconciliation, delinquency, adds, terms, and reinstatements. Able to answer detailed network, product, eligibility, claims and plan benefit questions. Service Advocates resolve questions and issues to help customers utilize products, tools, services, and directly contribute to customer satisfaction and retention across 17-23 separate systems. 

Essential Functions
  • The essential functions listed represent the major duties of this role, additional duties may be assigned. 
  • Serving as a "Universal" Service Advocate responding to inquires related to all segments including Medicare, Group, and Consumer (U65) across multiple functions (EM&B and Customer service). Contact includes internal and external customers requiring resolution via telephone, electronically and through written correspondence. Response includes follow up when appropriate. Resolve complex problems and inquiries related to:
    • Enrollment
    • Membership
    • Billing
    • Claims
    • Benefits
    • Member Web Site
    • CMS
    • Federal Market Place
    • GuideWell Campaigns
    • Vendor Arrangements: Prime, CareCentrix, New Dimensions, et al
    • Ancillary products
    • Escalations
Complete understanding of compliance with:
  • Federal and state regulatory requirements 
  • OIR requirements
  • CMS requirements
  • HIPPA guidelines
  • ACA compliance requirements
  • Grandfathered plans
  • Small/Med/Large group differences
  • Revenue Program Management (25%)
Complete understanding of the following enrollment and billing processes:
  • Invoices 
  • Posting of adjustments
  • Cancellations
  • Deletion of dependents 
  • Adding dependents
  • Refunds
  • Delinquency regulations and processes
  • Reinstatement Guidelines
  • Rate changes
  • Effect of address changes
  • Payment processing
  • APO and APO updates
  • Payment deadlines
  • Billing disputes
  • Medicare discount
  • ASO vs Fully Insured 
Complete understanding of the following claims and benefits processes:
  • Accumulators
  • Adjustments
  • Balance billing
  • Billing Disputes
  • Eligibility
  • Plan Transfer
  • Online Provider Directory
  • Provider or Hospital Par
  • Registration

Additional focus is on:
  • Building relationships with agents and members to maximize retention of business
  • Demonstrated ability to succeed in a multi-functional environment and have strong organizational skills and knowledge of various systems (17-23 unique systems) in order to perform daily functions
  • Must be able to execute and/or understand transactions on the following systems: RBMS, Siebel, Waypoint, Convergence, Sapphire, Diamond and Member’s Edge
  • Partner with agents and the Agent Service Center and participate in identification of root cause resolution for any outstanding issues
  • Must be able to manually review a member enrollment file viewing all debits and credits at the member level for a multi-year period ensuring accuracy of billing and enrollment
  • Consistently use the client's Call Strategy to provide outstanding customer service and call resolution to our members
  • Critically evaluate data through questioning, probing, and reasoning for process improvements
  • Provide guidance and expertise to less experienced Service Advocates
  • Resolve critical inquiries and ensure quality management of processes is in place
  • Serve as a subject matter expert for business requirements and automation development, corporate SO projects and workgroups, and SO training
Required Work Experience
  • 2+ years related work experience or equivalent combination of transferable experience and education. Experience Details: Customer service experience (retail, face to face, phone, chat) and experience with financial reconciliation and accounting activities 
  • Required Management Experience
  • No supervisory/management experience required 
  • Required Education
  • High school diploma or GED 
Additional Required Qualifications
  • Ability to work in a call center production environment serving members, answering questions, educating caller and resolving simple to complex issues 
  • Demonstrated ability to solve complex problems 
  • Ability to multi task across multiple systems and concepts 
  • Excellent verbal and communication skills 
  • Must be confident interacting with people and have the ability to be persuasive 
  • Must possess strong problem solving and decision making skills 
  • Successful match on job-related assessments/profile 
  • Experience working with PCs and standard office software, including Word, the Internet and web-based tools 
  • Ability to work assigned shift after successful completion of training
??Additional Preferred Qualifications
  • Knowledge of compliance requirements
  • Advanced computer skills
  • Some college
  • Experience working with financial products and services
  • Experience working with account reconciliation processing systems
  • Experience working with health insurance processing systems (RBMS, Siebel, Diamond, etc.)
  • Knowledge of FL Blue products (Blue Options, My Blue, Medicare, HMO, Dental, Life, Vision, etc.)
  • Bi-lingual (English/Spanish) a plus
  • 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. 
  • Driving
  • Incidental Driving
  • We are an Equal Opportunity Employer/Protected Veteran/Disabled.
If you believe that your skills and experience are a match for this position, please e-mail your resume to, or apply on line at (search jobs). 
If you have any questions, please call 904-998-9414 and reference Universal Service Advocate position.

Application Instructions

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