Service Advocate, V - Claims QIP (Homestead,FL)
Company: Florida Blue
Posted on: April 25, 2021
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
- 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
- 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
- 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
ADDITIONAL REQUIRED QUALIFICATIONS
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
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 Employer/Protected Veteran/Disabled.
Associated topics: adjuster, auto, bodily, claim examiner, damage,
insurance adjuster, insurance examiner, investigation, liability,
Keywords: Florida Blue, Homestead , Service Advocate, V - Claims QIP (Homestead,FL), Other , Homestead, Florida
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