Consumer Care Advocate

This is a fully remote position, open to applicants in Tennessee, +1 more state.

📋 Description

• Handle incoming calls, faxes, and voicemails from claimants, providers, clients, attorneys, and other stakeholders

• Address claims-related inquiries and issues in accordance with established guidelines and policies

• Communicate the status of claims and current activities to clients and relevant medical contacts

• Respond to inquiries that are specific to jurisdiction and claims

• Input data into the claims management systems

• Ensure that claim files are thoroughly documented and that claims coding is accurate

• Coordinate updates or changes to claimant addresses with internal departments

• Provide referrals to teams handling legal matters, utilization reviews, pharmacy issues, and Special Investigations Unit inquiries

• Arrange independent medical examinations

• Support the organization's quality assurance programs

• Carry out additional duties as assigned

⛳️ Requirements

• High school diploma or GED is mandatory

• Associate’s degree from an accredited college or university is preferred

• Relevant professional certification in line with business requirements is preferred

• A minimum of two (2) years of experience in administrative roles and/or customer service, or a combination of education and experience, is required

• Exceptional oral and written communication abilities

• Proficient in using PCs, including Microsoft Office applications

• Strong investigative and organizational skills

• Good interpersonal skills

• Capability to work effectively in a team setting

• Ability to meet or exceed established Performance Competencies

• Competence in managing multiple priorities concurrently and meeting deadlines

🏝️ Benefits

• Work-life balance

• Reasonable accommodations when applicable and appropriate

• Equal opportunity in the workplace

• Drug-free workplace