Client Advocate
NFP
Bethesda, MD
10.2013 - 01.2022
- Provided assistance with escalated insurance requests, including claims advocacy, billing, enrollment, concierge service for VIP's, appeals, referrals and authorization overrides
- Worked with large group clients of up to 1,000 employees, as well as mid-market employer groups between 20-50
- Liaised with medical, pharmacy, dental, vision, COBRA, HSA, HRA carriers to resolve enrollment, eligibility, benefits and claims issues
- Interpret Explanation of Benefits (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements
- Intermediate knowledge of hospital billing form requirements (UB-04), as well as some ICD-10, HCPCS/CPT coding and terminology
- Accurate benefits data entry directly into clients HRIS, Benefit Admin, Payroll and carrier systems
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals by prioritizing customer needs
- Monitored changes in insurance industry to assure clients stay compliant with relevant laws and regulations including HIPAA, CHIP, COBRA, FMLA and SBC's and state mandates
- Trained and mentored associates on performance-oriented strategies and customer service techniques.
- Attended seminars, meetings and educational programs to stay abreast of evolving needs of insurance industry and client base.