Customer Service Advocate III

Provides real-time support to peers on live calls, chats, and correspondence. Handle escalated provider calls, appeals, and denial overturn status requests through ServiceNow. Train and coach staff on claim procedures, policy guidelines, and HIPAA regulations. Monitor team performance metrics and encourage productivity through motivational feedback.

Managed up to 3 concurrent live chats helping providers with claims, referrals, and appeals. Delivered prompt resolution to inquiries and provided correct payment and processing updates. Reissued payments and guided providers on next steps for claim follow-ups.

Fielded provider calls about claim status, denials, and adjustments. Drafted formal correspondence letters in response to payment and claim issues. Flagged potential fraud, abuse, or waste, and escalated when necessary. Corrected and reprocessed erroneous claims using company claim systems.

Helped members with OTC product orders and handled complaints about shipping, missing items, or damaged goods. Issued claims for reshipment and provided tracking and resolution.

Processed and managed insurance certifications for health agents across multiple states. Updated internal systems to verify agents’ eligibility to sell insurance in designated markets.

Guided callers through pandemic unemployment applications and weekly certification processes. Provided technical support for documentation submission and eligibility troubleshooting.

Handled 30–40 inbound calls daily assisting customers with managing their home insurance policies. Coordinated directly with agencies to retrieve policy information and process payments or reinstatements.

Supervised 50+ employees, managed schedules, resolved customer disputes, and conducted audits. Ensured compliance with cash handling procedures and company standards.