Claims Customer Service Advocate

Job Summary

Working remotely after initial training, the full-time Claims Customer Service Advocate will respond to customer inquiries, adjudicate claims, and perform research to resolve complex issues while ensuring compliance with organizational policies.

Key responsibilities

• Respond to customer inquiries accurately and courteously, adapting responses as needed and conducting extensive research for resolution
• Examine and process claims and non-medical appeals, ensuring adherence to business regulations and internal standards
• Identify and escalate complex complaints and potential fraud situations to management for further action

Required qualifications

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