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.

Essential functions:

• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• 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.

Experience:

• 2+ years related work experience or equivalent combination of transferable experience and education.

Education:
High school diploma or GED.