Clinical Support Service Advocate -Remote

Get to Know Us!

GuideWell and its family of forward-thinking companies are focused on helping people and communities achieve better health and are at the forefront in the transformation of health care.

Florida Blue, a GuideWell Company, has been providing health insurance to residents of Florida for 75 years. Driven by its mission of helping people and communities achieve better health, the company serves more than five million health care members across the state. We are looking for exceptional people who will bring our mission to life and succeed by putting the member first.

What We Can Offer YOU!

We offer competitive salaries and benefits, work-life balance, flexible work arrangements, opportunities for growth and development, and a great place to work across our enterprise!

IMPORTANT FOR YOU TO KNOW:

Requires 9:30 a.m. to 6:00 p.m. shift coverage.

What You Will Be Doing:

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.

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

What You Must have:

2+ years related work experience or equivalent combination of transferable experience and education to include customer service and medical benefits experience in a call center environment.

High school diploma or GED.

What We Prefer You To Have:

High comfort level working in an inbound call center environment.

Strong customer service experience.

Experience with Workforce Management Scheduling.

Claims software experience (Jiva, Diamond, Provider Connect and Customer Connect).

Experience working with healthcare products including researching and resolving provider inquiries and working with provider contracts and networks.

Experience working with medical terminology, CPT-5 coding, ICD-10 coding and claims adjudication inquiry resolution processes and procedures.

Identify, document and monitor process improvements.

Experience working with MS Word and Excel.

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.