Florida Blue – Remote Claims Rep | $18 – $27 an Hour | Start Date 9/30
Website Florida Blue
Start date: 09/30/24
Training duration and hours: 09/30/24 – 12/13/24, Monday through Friday between 8:00 am to 5:00 pm EST
Shift after training: Will be assigned a 8 hour shift with scheduled breaks between 6:00 am to 6:00 pm Monday through Friday, EST
Job Summary
Roles in the Federal Employee Program Claims sub-family review and adjudicate claims; determine whether to return, deny or pay claims following policies and procedures; process subrogation, workers' compensation and other claims where third party liability may exist; recover overpayments, and answer inquiries from other internal departments, insurance adjustors, attorneys and members. Representative Role Responsibilities: The work of a Service Advocate III is guided by instructions, established work routines and/or close supervision. Incumbents are given some latitude on deciding on how tasks and duties are completed based on changing work situations, work flow, etc. and supervisory approval. Incumbents perform semi-routine duties within established systems and procedures.
Essential Functions:
Process credit listing functions, aged listings and held claims.
Process adjustments by working with ambulance services, inpatient facility services and others.
Determine whether to return, deny or pay claims following contract benefit and organizational processing guidelines.
Perform additional research to develop claims; includes contacting providers or members.
Provide customer service and education to plan members and providers by answering more complex questions regarding insurance claims and policies, resolving issues and ensuring customers understand the Company’s products, services and processes. Calls are predominantly routine, but may require deviation from standard screens, scripts and procedures.
Perform research to respond to inquiries and interpret policy provisions to determine most effective response.
Use computerized systems for tracking, information gathering and troubleshooting.
Actively seek, identify and implement process improvement opportunities.
Perform other duties as assigned
Required Work Experience:
1 years related work experience.
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:
- 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, and 11 holidays
- Additional voluntary benefits available; and
- A comprehensive wellness program
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 – $27
Hourly Hiring Rate: $18
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.
URL: https://fa-etum-saasfaprod1.fa.ocs.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/40215/
To apply for this job please visit fa-etum-saasfaprod1.fa.ocs.oraclecloud.com.
