Service Advocate IV - Clinical Support

WEB-TPA, Inc.; Jacksonville (FL); Hybrid; USD 26,000 - 41,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Benefits

Retirement Plan

Paid time off

Holidays

Job summary

Florida Blue is seeking a Service Advocate to deliver customer service to plan members and providers, coordinate referrals, and verify insurance coverage. The role supports clinical processes with a hybrid work arrangement, and occasional travel to corporate or regional offices may be required.

The position emphasizes resolving inquiries, educating members on products and services, and collaborating with hospitals, physicians and vendors to ensure satisfaction and timely access to care.

Qualifications

• 2+ years related work experience.
• High school diploma or GED.

Responsibilities

• Provides customer service to plan members and/or providers by answering benefit questions, researching and resolving issues and inquiries and ensuring members and providers understand the Company’s products and services.
• Acts as a liaison between hospitals, physicians, health plans, vendors, patients or referral sources.
• Initiates and manages clinical referrals for members.
• Verifies insurance coverage and obtains authorizations if needed.
• Enters referrals and documents communications, actions and other data in departmental systems.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient certification and/or prior authorization requests.
• Refers cases requiring clinical review to appropriate clinical professionals.
• May provide guidance and expertise to less experienced Service Advocates.

Skills

Customer service

Education

High school diploma or GED

Job description

The role of a Service Advocate is focused on servicing current or potential customers, providers, agents, brokers, benefit administrators or consultants. The major accountability of this role is customer, provider, agent, broker, benefit administrator or consultant satisfaction.
Job duties include but are not limited to:

• Provides customer service to plan members and/or providers by answering benefit questions, researching and resolving issues and inquiries and ensuring members and providers understand the Company’s products and services
• Acts as a liaison between hospitals, physicians, health plans, vendors, patients or referral sources
• Initiates and manages clinical referrals for members
• Verifies insurance coverage and obtains authorizations if needed
• Enters referrals and documents communications, actions and other data in departmental systems
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient certification and/or prior authorization requests
• Refers cases requiring clinical review to appropriate clinical professionals
• May provide guidance and expertise to less experienced Service Advocates

Job Requirements:

• 2+ years related work experience
• High school diploma or GED

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.

This position offers a hybrid work arrangement which combines flexibility with in-office engagement. Team schedules are determined based on role requirements and business needs. Travel to and from our corporate or regional offices may be required.

What We Offer:

As a Florida Blue employee, you will be at the heart of GuideWell's vision - to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Hourly Pay Range: $19 - $30

Typical Hourly Pay Range: $19 - $23

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.