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Service Advocate, V - Claims QIP (Homestead,FL)

Company: Florida Blue
Location: Homestead
Posted on: April 25, 2021

Job Description:

Service Associate V Claims - QIP is a production based role responsible for reviewing and adjudicating of high risk claims. Individuals in this role are multifaceted and support the business through their flexibility to ensure optimum quality results. Incumbents provide training and feedback to service advocates who service current or potential customers (which are defined as members, providers, agents, brokers, benefit administrators or benefits consultants).


  • The essential functions listed represent the major duties of this role, additional duties may be assigned.
  • Review and adjudicate high-risk claims. (50%)
  • Support continuous improvement efforts through the early identification, investigation and resolution of problems by communicating and coordinating with the appropriate contacts for completion. (15%)
  • Interact with numerous areas throughout the company to research information and recommend solutions. (15%)
  • Facilitate weekly calls with vendors that include detailed discussions regarding claims processing and status of outstanding issues. (10%)
  • Identify formal education opportunities and needs and communicate these to the appropriate personnel. Provide one-on-one coaching and continuous education for front-line staff. (10%)REQUIRED WORK EXPERIENCE
    3+ years related work experience. Experience Details: claims, customer service and healthcare related experience

    High school diploma or GED

    Knowledge and understanding of health insurance plans, terminology, benefits and claims processing
    Ability to work within strict time frames
    Perform analysis to determine root cause of issues and escalate to leadership as appropriate
    Demonstrated ability to succeed in a multi-functional environment and have strong organizational skills and knowledge of various systems

    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 Employer/Protected Veteran/Disabled. Associated topics: adjuster, auto, bodily, claim examiner, damage, insurance adjuster, insurance examiner, investigation, liability, title examiner

Keywords: Florida Blue, Homestead , Service Advocate, V - Claims QIP (Homestead,FL), Other , Homestead, Florida

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