Customer Advocate Specialist for Expedited Appeal Cases
Customer Service Advocate II (Former Employee) – Abilene Texas – September 4, 2015
Provide concierge customer service to members and providers through working production with appeal requests (clinical, non-clinical, and third party) and with predetermination requests for service. Assigned primarily to Expedited Appeals, Pre-service medical and Medication requests with a 48/72 hour timeline of completion. Assigned to on call responsibilities on a rotational basis.
Expedited Appeals are for the potential for loss of life or limb circumstances.
Responsible for accurate research and documentation of information
Responsible for providing accurate information of inquiry
Responsible for research, compilation, and response from the Medical Review Unit to the members and to the providers
Responsible for communication to the patient and to the provider in appeal finalization of appeal determination.
I really enjoy the flexible shift and the ability to work from home as needed.
It is a high demanding job and can be stressful.