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Service Advocate III, FEP Claims Processing
GuideWell Source. Review and adjudicate high risk claims .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates the ability to review and adjudicate high risk claims while effectively processing adjustments and providing customer service to plan members and providers. Proficient in using computerized systems for tracking and information gathering, with a focus on identifying process improvement opportunities.
Highest-signal resume keywords
High Risk Claims AdjudicationClaims ProcessingCustomer Service SkillsPolicy InterpretationComputerized Systems Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationClaims ProcessingSubrogation ProcessingWorkers’ CompensationThird-Party LiabilityCredit Listing FunctionsAged ListingsAdjustments ProcessingResearch SkillsInformation Gathering
Soft Skills
Customer ServiceEducation SkillsProblem SolvingCommunication Skills
Tools & Technologies
Computerized Systems
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
Insurance ClaimsContract BenefitsOrganizational Processing Guidelines
About the role
Key responsibilities & impact- Review and adjudicate high risk claims
- 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
- Conduct additional research to develop claims, including contacting providers or members
- Provide customer service and education to plan members and providers regarding insurance claims and policies
- Answer complex questions, resolve issues, and explain company products, services, and processes
- Research inquiries and interpret policy provisions to determine effective responses
- Use computerized systems for tracking, information gathering, and troubleshooting
- Identify and implement process improvement opportunities
- Perform other assigned duties
Requirements
What you’ll need- 0–1 years related work experience
- High school diploma or GED
- Ability to review and adjudicate high risk claims
- Ability to determine whether to return, deny, or pay claims according to contract benefits and organizational processing guidelines
- Ability to process subrogation, workers’ compensation, third-party liability, credit listing functions, aged listings, held claims, and adjustments
- Ability to research claims and contact providers or members
- Customer service and education skills for plan members and providers
- Ability to interpret policy provisions
- Proficiency using computerized systems for tracking, information gathering, and troubleshooting
- Ability to identify and implement process improvements
- Sedentary work capacity, exerting up to 10 pounds occasionally
- No supervisory or management experience required
Benefits
Comp & perks- Medical, dental, vision, life and global travel health insurance
- Income protection benefits, including life insurance and short- and long-term disability programs
- Leave programs to support personal circumstances
- Retirement Savings Plan including employer match
- Paid time off
- Volunteer time off
- 10 holidays
- 2 well-being days
- Additional voluntary benefits
- Comprehensive wellness program
- Opportunities for incentive or commission compensation
- Annual reviews with pay for performance considerations for base pay increases