Subject Matter Expert to Tier I and Tier II advocates offering training and assistance.
- Proficient in Siebel, Diamond, Convergence, Quest, Availity, JIVA ARCHER, SAP P eople So ft and Microsoft Office products.
- Providing excellent customer service in a high volume call center while maintaining quality, productivity and adherence.
- Research ing and providing status on claim processing, payments, denials and adjustments in accordance with the member's benefit s.
- Responsible for ensuring the provider's contract details are updated and fee schedules are accurate, all provider identification numbers are coordinated with National Provider Identification/Tax Identification numbers correctly and submitting all address changes for completion.
- Responding to inquiries regarding benefits and eligibility for all lines of business.
- Researching, reviewing and providing status of prior authorizations. Health Insurance Caseworker
- Responsible for updating eligibility according to files received from the Healthcare Marketplace.
- Calling the member for every case received from the Marketplace and keeping them informed of status.
- Familiar with the different tiers of insurance provided by the government.
- Responding to every case outlining all updates. Strategic Provider Advocate
- Outbound Service Advocate for Strategic Provider Services. Responsible for assisting high volume providers reduce t heir outstanding balances.
- Processing new claim entry and claim adjustments.
- Reviewing aged appeals, returning invalid appeals, processing any authorization appeals and escalating all others.
- Working with other Blue Plans either telephonically or through Blue Squared for all out of state inquiries.
