Claims Service Advocate; Special Accounts Team

A day in the life

The Claims Service Advocate is responsible for reviewing moderately complex health insurance claims and providing customer service to members, providers, and/or customers by telephone, computers, and/or written inquiry. This position determines how to apply benefits and whether to return, deny, or pay claims following organizational policies and procedures.

• Utilize various systems and process guidelines to review, process, and adjudicate moderately complex claims, ensuring quality, accuracy, and timeliness standards are met.
• Review moderately complex claim inquiries by analyzing, interpreting, and researching the request to determine appropriate action, and initiate any requests to update member information when necessary.
• Respond to incoming reports, medical records, and other related documents to make claim determinations for additional processing.
• Provide information, guidance, and education to members and customers in complex and escalated situations while working in close partnership with other internal departments to ensure customer satisfaction.
• Conduct research on behalf of members, providers, and customers, including reviewing documents, statements, and information supplied by other outside agencies.
• Handle incoming and outgoing customer service calls in a clear and concise manner.
• Perform work under general supervision, handling moderately complex issues and referring more complex issues to higher-level staff.

• A High School Diploma/GED and 3 years of experience in customer service, claims processing, or related experience.
• Problem‑solving skills with the ability to research, analyze, and define methods, practices, and procedures to resolve issues.
• Ability to communicate clearly and professionally in both verbal and written formats.
• Ability to work effectively with others, valuing diverse perspectives and fostering teamwork.
• A creative mindset and a go‑get‑em attitude to find ways to improve processes and projects.
• Strong ability to prioritize and organize work with varying timelines for projects and daily work.

• Pay Level: 017
• FLSA Category:
  Nonexempt - Hourly
• Individual pay based on skills, experience, qualifications, location, internal equity, and other relevant factors.
• Opportunities for continued salary growth through a performance-based merit program.
• Estimated starting pay: $18.70 - $25.00.

• Affordable medical, dental, and vision coverage accepted throughout the United States
• Employer‑funded Lifestyle Spending Accounts and Health Savings Accounts, with voluntary employee contributions to Health Savings Accounts and Flexible Spending Accounts
• Employer‑paid life and disability insurance
• 401(k) retirement plan with company match and immediate vesting
• Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
• Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.

• Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
• Comprehensive learning and development opportunities and an Educational Assistance Program.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events, and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Opportunities to connect through employee committees.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

This posting is scheduled to close on 06/24/26 at 8:00 a.m. (CT). It may be closed earlier if a high volume of qualified applications is received. Candidates must be legally authorized to work in the United States at the time of application and for the entire duration of employment without the need for sponsorship.