Customer Service Advocate I- MD July (Remote)

PURPOSE:

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Responsible for answering member, provider & broker inquiries about product information, benefits, claims resolution, eligibility, and billing questions in a call center environment.

Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications.

ESSENTIAL FUNCTIONS:

  • Provides first-level problem resolution to member, provider & broker inquiries via telephone by gathering and researching information; examines claim submissions verifying claim and system accuracy as well as liability, validates customer understanding of information and resolves issues based on applicable policies and procedures.
  • Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer to provide benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. Appropriately documents all client interactions according to established departmental procedures.
  • Delivers accurate information to customers under performance goals and objectives.
  • Maintains customer records by updating account information by effectively utilizing the business area enrollment/inquiry tracking system & processes.
  • Participates in ongoing education related to new services, industry topics, and skills.

 

QUALIFICATIONS:


Education Level: High School Diploma or GED.

Experience: Less than one year of customer service experience.

 

Preferred Qualifications:

  • Less than 1 year experience in a call center customer service role or experience with medical or insurance terminology.

 

Knowledge, Skills, and Abilities (KSAs)

    • Successful completion of the training provided.
    • Demonstrated skills as an empathetic and compassionate communicator.
    • Ability to quickly gain customer trust and confidence.
    • Demonstrated PC navigation and data entry skills.
    • Strong interpersonal communication skills.
    • Good oral and written communication skills.

Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

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