Customer Advocate Level I

Position Summary

As a Customer Advocate at MedRisk/SPNet, you will serve as a crucial communication link between network providers and referring adjusters and nurse case managers. Reporting to the Customer Advocate Team Lead or Supervisor, your role is vital in enhancing MedRisk/SPNet’s referral process, ensuring operational efficiency, and boosting customer satisfaction. You will act as a liaison, meticulously tracking patient progress from the initiation of treatment through its completion. This involves gathering essential case updates from providers, such as dates of service, compliance status, treatment notes, and continued authorization requests. Maintaining the accuracy of case files and related documentation, along with professional and effective communication with all parties, is paramount.

Primary Duties & Responsibilities (Level I)

• Oversee claims and monitor case progression by verifying patient appointments with network providers and addressing any compliance-related issues.
• Accurately update all case-specific data within MedRisk’s database and platform.
• Manage and communicate treatment authorizations to providers as per client instructions, ensuring confirmation with adjusters and nurse case managers.
• Develop a thorough understanding of each client's specific requirements and respond accordingly.
• Cultivate professional and approachable relationships with both network providers and referring customers.
• Adhere strictly to HIPAA and URAC guidelines.
• Maintain a productivity standard of at least 60 tasks per day.

Qualifications

• A Bachelor's degree is preferred, coupled with exceptional customer service abilities and 2-3 years of relevant experience.
• Prior healthcare experience is required, with a minimum of 1 year preferred.
• Experience working with a US-based company is necessary.
• Demonstrated ability to work autonomously and manage multiple tasks effectively in a dynamic, fast-paced setting.
• Keen attention to detail.
• Excellent verbal and written communication proficiencies.
• Proficiency in basic Microsoft Word, Excel, Outlook, and Zoom.
• Competence in using Windows-based computer systems.
• Strong time management and organizational capabilities.
• High adaptability to changing circumstances.
• Openness to receiving and acting upon constructive feedback.
• A robust work ethic.