Claims Processing Pro: Advocate III

Florida Blue Group; Jacksonville (FL); On-site; USD 25,000 - 39,000; Full time

Job summary

Florida Blue Group in Florida is seeking a Service Advocate III to review and adjudicate claims, determine pay or denial, and handle subrogation and related inquiries.

This role operates under guidance with some autonomy, uses computer systems, and seeks process improvements while supporting internal departments and members. The ideal candidate has 0-1 years of experience and a high school diploma or GED.

Qualifications

• High school diploma or GED required.
• 0-1 years related work experience.

Responsibilities

• Review and adjudicate high risk claims.
• Process credit listing functions, aged listings and held claims.
• Process adjustments by working with ambulance services, inpatient facility services and others.
• Determine whether to return, deny or pay claims following contract benefit and organizational processing guidelines.
• Perform additional research to develop claims; includes contacting providers or members.
• Provide customer service and education to plan members and providers by answering more complex questions regarding insurance claims and policies, resolving issues and ensuring customers understand the Company's products, services and processes.
• Calls are predominantly routine, but may require deviation from standard screens, scripts and procedures.
• Perform research to respond to inquiries and interpret policy provisions to determine most effective response.
• Use computerized systems for tracking, information gathering and troubleshooting.
• Actively seek, identify and implement process improvement opportunities.
• Perform other duties as assigned.

Education

High school diploma or GED

Job description

Florida Blue Group in Florida is seeking a Service Advocate III to review and adjudicate claims, determine pay or denial, and handle subrogation and related inquiries.

This role operates under guidance with some autonomy, uses computer systems, and seeks process improvements while supporting internal departments and members. The ideal candidate has 0-1 years of experience and a high school diploma or GED.