Insurance Client Advocate I, CIS


Insurance Client Advocate I, CIS

This position is responsible for providing excellent customer service, responding to customer inquiries, including reimbursement processing, order placement, shipping status, warranty and general concerns. Assists with benefits investigation and answers a variety of reimbursement related questions. Strong communication between patients, physicians, healthcare and insurance providers are critical functions of this position.

The Customer Care Specialist is able to independently follow standardized workflows as defined by the organization. Customer service experience is required, reimbursement/insurance and healthcare experience is preferred. The Customer Care Specialist is not only responsible for ensuring a positive customer interaction, but will also ensure that benefits/coverage, prior authorization and documentation is correctly obtained which will allow the client to be successfully.


  • Using their advanced knowledge and skill set, this position could be called upon to complete a wide range of task within the Reimbursement team.
    • Collaborate with other commercial teams such as Case Management, OmniPod Sales and Billing, to ensure proactive communication of potential customer’s order status.
    • Calculate and document cost share amounts for potential customers.
    • Submission of all prior authorization requestsInsulet for approval and payment of the clients products at time of claim processing.
    • Process all aspects of reimbursement by contacting payors, verifying insurance benefits and adhering to medical guidelines for reimbursement.
    • Serving as a department expert on all client insurance contracts, channeling and processing requirements for all covered products.
    • Provide frequent feedback and suggestions to support an environment of continuous process improvement.
    • Responsible for maintaining satisfactory call and order counts as defined by management.
    • Document all interactions and calls into the customer database and maintain compliance to HIPAA and other regulating bodies as required.
    • Work as part of the larger support team, collaborating with other departments to ensure proactive, superior front-line customer support.
    • Answering phone inquiries and providing support and direction to customers and resolving customer service issues in a timely and empathetic manner.
    • Understand the clients channeling and processing requirements for all covered products, which is based on medical policy and payer guidelines.
    • Must maintain a thorough understanding of products offered by the client with the ability to explain to potential or existing customers the basic operation and use.
    • Requesting and collecting updated documentation, prior authorizations, order entry and coordinating shipment of product to customers.
    • Process all aspects of the order process by verifying insurance benefits/coverage to determine eligibility and calculate cost share amounts for existing and new customers.
    • #NACNX