- The essential functions listed represent the major duties of this role, additional duties may be assigned.
- Provides feedback and claims instructions to various internal areas.
- Acts as subject matter expert to the line area.
- Supports claims processing, events and internal audit.
- Processes adjustments, reworks, corrected claims and transplant claims.
- Processes high dollar claims, workers' compensation and other claims where third party liability may exist.
- Requests additional information from the provider or member if necessary to develop claims.
- Recovers overpayments by researching paid claims, answering inquiries and interacting with other departments, insurance adjustors, attorneys and members.
- Researches, balances and applies claims overpayment refunds to the appropriate claim system patient files when cash refunds are received.
- Provides services to providers by researching, analyzing, maintaining and collecting overpaid claims.
- Validates claims overpayments and identifies and resolves issues related to the overpayment of claims.
- Actively seeks, identifies and implements process improvements opportunities.
- Medical, dental, vision, life and global travel health insurance;
- Income protection benefits: life insurance, Short- and long-term disability programs;
- Leave programs to support personal circumstances;
- Retirement Savings Plan includes employer contribution and employer match;
- Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days
- Additional voluntary benefits available; and
- A comprehensive wellness program
Claims Representative, Remote - Florida Blue
Description
JOB DESCRIPTIONStart date : 07/08/2024
Training duration and hours: 07/08/ /06/24, Monday through Friday between 8 am to 5pm EST
Shift after training: Will be assigned an 8-hour shift with scheduled breaks between 6:00 am to 6:00 pm Monday through Friday, EST (department is open until 10 pm M-F, nights are not mandatory)
Set Pay: $19.04
Job Summary:
The role of the 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:
Required Work Experience:
2+ years related work experience. Experience Details:
Required Education:
High school diploma or GED
General Physical Demands:
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Hourly Pay Range: $18 - $29
Set Pay: $19.04
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.