Customer Service Advocate II

Job Description

Do you have a passion for helping others and making a positive impact on their lives? Are you looking for a challenging and rewarding career in the healthcare industry? If so, Imagenet is seeking exceptional Customer Service Advocate II to join our team.

As a Customer Service Advocate II, you will play a vital role in our organization, providing exceptional service to our clients and ensuring their satisfaction. You will be responsible for:

Policy Management

• Billing: Process member payments, address billing inquiries, and resolve billing discrepancies.

• Member Information Updates: Update member information accurately and promptly, including addresses, phone numbers, beneficiaries, and employment details.

• Policy Terminations and Reinstatements: Handle policy termination requests, process policy terminations effectively, and assist with policy reinstatements.

• ID Card Ordering: Process ID card orders efficiently, ensure timely delivery, and address any ID card-related concerns.

Benefits

• Coverage Information: Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions.

• Prior Authorization and Referrals: Assist members with prior authorization and referral processes, guiding them through the procedures and requirements.

• Healthcare Provider Contact Research: Conduct thorough research to locate contact information for healthcare providers, ensuring accurate and up-to-date information for members.

Claims

• Claims Status Updates: Provide accurate and timely status updates on claims, explaining the processing stages and addressing any concerns.

• Claims Inquiries: Answer questions about claim processing, explaining claim denials, and providing guidance on submitting appeals.

• Claims Reconsideration Requests: Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals.

General Inquiry

• Website Troubleshooting: Assist members with troubleshooting issues related to the member website, guiding them through navigation and resolving technical problems.

• General Questions: Answer general questions about health insurance plans, providing comprehensive and accurate information on various topics.

Additional Responsibilities

• Maintain Confidentiality: Adhere strictly to confidentiality policies and safeguard sensitive member information.

• Escalate Complex Issues: Escalate complex issues to supervisors or managers for further assistance and resolution.

• Continuous Learning: Stay updated on changes in health insurance regulations, policies, and procedures.

• Contribute to Team Success: Collaborate effectively with team members to achieve shared goals and maintain a positive work environment.