Service Advocate IV - Clinical Support

About the role

The Service Advocate role is focused on servicing current or potential customers, providers, agents, brokers, benefit administrators, or consultants. The primary accountability is ensuring customer, provider, agent, broker, benefit administrator, or consultant satisfaction.

Responsibilities

• Provides customer service to plan members and/or providers by answering benefit questions, researching and resolving issues and inquiries, and ensuring members and providers understand the Company’s products and services.
• Acts as a liaison between hospitals, physicians, health plans, vendors, patients, or referral sources.
• Initiates and manages clinical referrals for members.
• Verifies insurance coverage and obtains authorizations if needed.
• Enters referrals and documents communications, actions, and other data in departmental systems.
• Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient certification, and/or prior authorization requests.
• Refers cases requiring clinical review to appropriate clinical professionals.
• May provide guidance and expertise to less experienced Service Advocates.

Requirements

• 2+ years of related work experience.
• High school diploma or GED.

General Physical Demands: Sedentary work involving exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

This position offers a hybrid work arrangement, combining flexibility with in-office engagement. Team schedules are determined based on role requirements and business needs. Travel to and from corporate or regional offices may be required.

Benefits

• Medical, dental, vision, life, and global travel health insurance.
• Income protection benefits: life insurance, short- and long-term disability programs.
• Leave programs to support personal circumstances.
• Retirement Savings Plan including employer match.
• Paid time off, volunteer time off, 10 holidays, and 2 well-being days.
• Additional voluntary benefits available.
• A comprehensive wellness program.

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time, and seasonal employees may differ.

Pay

Hourly Pay Range: $19 - $30

Typical Hourly Pay Range: $19 - $23

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring. Opportunities for incentive or commission compensation may also be available. Regular annual reviews include pay-for-performance considerations for base pay increases.