Customer Care Advocate
Current- Engaged with members to understand and resolve complex billing and claims issues, provide insurance benefits, and connect with health professionals to address urgent health concerns.- Reviewed and processed insurance claims for accuracy, completeness, and compliance with company policies and regulatory requirements, maintaining a 98% accuracy rate.- Investigated and evaluated claims by gathering relevant information, analyzing documentation, and conducting interviews with claimants and witnesses.- Determined claim eligibility, coverage, and liability based on policy terms, contract provisions, and legal guidelines.- Communicated claim decisions and settlements to policyholders, attorneys, and other stakeholders in a clear and timely manner, ensuring customer satisfaction and retention.