Customer Experience Advocate

About This Role

As a Customer Experience Advocate, you will serve as the primary voice of support for clients and their employees, handling calls and emails, resolving issues, and ensuring positive interactions. You will manage and authorize claim payments while upholding service and timeframe standards.

Responsibilities

• Manage pilot line calls and email communications to provide reactionary responses within claims
• Administer and authorize payment on claims while adhering to service, timeframe, and production standards
• Communicate with claimants, employers, and medical professionals to gather information regarding eligibility, benefit authorization, and ongoing benefit management
• Apply appropriate contractual provisions, case management resources, and claim processes to ensure accurate eligibility requirements and liability decisions
• De-escalate calls submitted by Absence Specialists
• Deliver excellent customer service and industry knowledge for inquiries
• Assist in the training of new employees as needed

Requirements

• High School diploma
• Two years of STD/LTD claims adjudication experience
• Ability to learn medical terminology and conditions
• Ability to interpret procedures and regulations
• Knowledgeable in Excel, Word, and web-based systems
• Excellent verbal and written communication skills
• Knowledge of ERISA regulations, required offsets and deductions, disability duration, and Social Security procedures
• Demonstrated ability to gather and analyze information, determine a course of action and implement it
• Strong ability to identify, analyze and solve problems
• Effective interpersonal skills capable of dealing with external sources and all levels of employees

Qualifications

• High School diploma
• 2+ years of STD/LTD claims adjudication experience

Nice to Have

• Experience in the TPA or self-administration services
• Experience with FMLA/State leave claims

Skills

* Required skills