Fcmb Claims Customer Service Advocate Ii Jobs

Responds to, research and/or assists with priority inquiries and special projects as required by management.

Provides feedback to management regarding customer problems, questions and needs.

Maintains accurate records on complaints and/or other customer comments and makes recommendations for changes to management.

Follows through on complaints until resolved or reports to management as needed.

Maintains basic knowledge of quality work instructions and company policies.

1 year of claims processing or customer service experience OR bachelor's degree in lieu of work experience.

Good verbal and written communication skills

Good spelling, punctuation, and grammar skills

Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines

Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines

Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes

Ensure claims are processing according to established quality and production standards

Respond to, research and/or assist with priority inquiries and special projects as required by management

Provide feedback to management regarding customer problems, questions and needs

Maintain accurate records on complaints and/or other customer comments, and makes recommendations for changes to management

Follow through on complaints until resolved or reports to management as needed

Maintain basic knowledge of quality work instructions and company policies

1 year of claims processing or customer service experience OR Bachelor's Degree in lieu of work experience

Continuing education funds for additional certifications and certification renewal

401(k) retirement savings plan with company match

Subsidized health plans and free vision coverage

Paid annual leave – the longer you work here, the more you earn

On-site cafeterias and fitness centers in major locations

Wellness programs and healthy lifestyle premium discount

Identify and report potential fraud and abuse situations

Complete projects and/or assignments related to claims processing and customer service functions in the department

High School Diploma or equivalent

Ability to follow policies and procedures

Ability to review claims and appeals

Subsidized health plans, dental and vision coverage

5 years-of experience processing and adjudicating claims.

Knowledge of mathematical and statistical concepts.

Proficient in word processing and spreadsheet applications. proficient database software skills.

Preferred Software And Other Tools

We Prefer That You Have

Flexibility with remote, work from home schedule

Provide eligibility status and benefit information for participants

Address both participant and provider inquiries (Including authorization status and requirements) and if unable to resolve, escalate as appropriate

Minimum of one (1) year of experience working in a call center environment where a service/support role was primarily performed

Excellent organizational and communication experience

Benefits of Working at WelbeHealth:

Provide feedback to management regarding customer issues.

Follow through on complaints until resolved or report to management as needed.

Maintain knowledge of procedures and policies.

Good verbal and written communication skills.

Good spelling, punctuation, and grammar skills.

One year of call center experience.

Respond accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals and other technical issues

Identify issues with procedures and processes and provides feedback to management on changes and development

Excellent verbal and written communication skills

Knowledge of claims processing procedures

Investigate and initiate resolutions to complex problems

Authorize payment recovery, claim payments, or makes claim rejections based on documented information and provisions of state or federal law

A proven curriculum providing the knowledge you need to excel.

Our Comprehensive Benefits Package Includes

Best-in-class call center training program.

Peer coach to observe you.

Peer coach for you to observe.

A training lab where you take live calls with a training supervisor close by to answer questions.