The Member Advocate provides dedicated support to members and healthcare providers by responding to inquiries received by phone, fax, email, and mail to resolve balance billing issues and disputes. Working independently within a clearly defined scope, the Advocate ensures every interaction is handled with accuracy, professionalism, and empathy. Key responsibilities include coordinating and prioritizing multiple time-sensitive tasks, maintaining an organized, efficient workflow, and directing issues to the appropriate resources to ensure timely and effective resolution.
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Processes medical, dental, and vision claims, answers questions in accordance with relevant terms and established procedure, and handles complex claims issues.