Member Service Advocate - Claims

Member Service Advocate

The Member Service Advocate is responsible for handling inquiries on existing claims, including providing accurate status updates for pending claims and assisting in completing requirements or resolving issues on behalf of the member or beneficiary.

The Member Service Advocate will serve as a personal guide throughout the claims process to ensure a consistent experience for our members and beneficiaries. They will help beneficiaries complete documentation requirements to enable claim files to be prepared for adjudication, while maintaining confidentiality and ensuring accuracy and completeness.

Monday-Friday, 11 : 30am-8pm EST, every 4th Saturday, 11am-3pm EST. $20 / hour. This position is fully remote.

Responsibilities

• Manage incoming claims communication (phone calls, chat, email, and mail) from members, agents, and beneficiaries and resolve issues on existing claims.
• Identify roadblocks and other issues preventing claims from being paid, serving as a resource for beneficiaries and other key stakeholders to complete requirements.
• Review documentation for accuracy for each claim filed to ensure it fulfills all procedural and regulatory requirements.
• Document detailed notes regarding the review, analysis, information needed based on specific policy forms :
• Update and file documents required for adjudication
• Learn all product types
• Review policy forms
• Translate specific claim requirements and communicate in clear language while building rapport and empathy with members, beneficiaries, and agents
• Provide first call resolution for existing customer issues

Qualifications

What We Offer :