Claims Customer Service Advocate

Job Summary

Providing thorough and courteous responses to complex customer inquiries, the full-time remote Claims Customer Service Advocate III will adjudicate specialty claims, perform research to resolve inquiries, and ensure compliance with organizational policies and procedures.

Key responsibilities

• Review and research claims or appeals issues to determine adherence to guidelines and identify underlying causes
• Respond to complex customer inquiries while ensuring contract standards for timeliness and quality are met
• Examine and process claims and non-medical appeals according to business regulations and internal standards

Required qualifications

• 3 years of customer service experience, including 1 year of claims or appeals processing experience, or a Bachelor's Degree in lieu of work experience
• High School Diploma or equivalent
• Proficiency in Microsoft Office
• Ability to handle confidential or sensitive information with discretion
• Strong customer service skills