Clinical Support Service Advocate -Remote

Get to Know Us! GuideWell and its family of forward-thinking companies are focused on helping people and communities achieve better health and are at the forefront in the transformation of health care.
Florida Blue, a GuideWell Company, has been providing health insurance to residents of Florida for 75 years.
Driven by its mission of helping people and communities achieve better health, the company serves more than five million health care members across the state.
We are looking for exceptional people who will bring our mission to life and succeed by putting the member first.
IMPORTANT FOR YOU TO KNOW: Requires 9:30 a.
m.
to 6:00 p.
m.
shift coverage.
Position can be performed remotely.
What is your impact: The 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.
What are your 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.
The essential functions listed represent the major duties of this role, additional duties may be assigned.
What is required: 2+ years related work experience or equivalent combination of transferable experience and education to include customer service and medical benefits experience in a call center environment.
High school diploma or GED.
What is preferred: High comfort level working in an inbound call center environment.
Strong customer service experience.
Experience with Workforce Management Scheduling.
Claims software experience (Jiva, Diamond, Provider Connect and Customer Connect).
Experience working with healthcare products including researching and resolving provider inquiries and working with provider contracts and networks.
Experience working with medical terminology, CPT-5 coding, ICD-10 coding and claims adjudication inquiry resolution processes and procedures.
Identify, document, and monitor process improvements.
Experience working with MS Word and Excel.
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.
What We Offer: As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
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 includes employer contribution and employer match.
• Paid time off, volunteer time off, and 11 holidays • Additional voluntary benefits available; and • A comprehensive wellness program Annualized Salary Range: $18.
00 -$28.
00 Typical Annualized Hiring Range: $18.
00 -$22.
00 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 Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees