Outbound Member Services Advocate

Key Responsibilities/Duties – what you will be doing (top five):

• Provides education either verbally or in writing to members on their products, policies, and procedures.  This can be conducted on an inbound or outbound call, in-person walk-ins, via email, or onsite at an office location.  Work collaboratively with stakeholders to proactively outreach to members to educate on service issues that may impact care or coverage. Offers assistance to team members in ways such as ensuring accuracy and to further develop their knowledge.  Distinguishes oneself by virtue of ability to coach and mentor in a professional and respectful manner.
• Acts as a resource to Member Support team members, as well as internal and external customers with complex issues; obtain appropriate background information to assist and oversee the troubleshooting and resolution of all inquiries.  May require performing and/or coordinating of related research activities and involving other departments as needed in order to effectively address issues presented.  May include evaluating issue trends and making recommendations for resolution.
• Maintains documentation of logs, status reports, all correspondence, meeting minutes, and any other pertinent documentation for tracking and reporting purposes. Provide documented issue briefs, summaries or reports to management, as required.
• Sets daily goals to ensure that all issues are resolved. Maintain or exceed productivity expectations by prioritizing tasks to meet customer’s needs.  Collaborate with colleagues and leadership team to set schedules that allow for timely issue resolution.
• Mentors new and existing staff related to issues such as outreach, escalations, workflows, and projects in order to assist them in independently resolving similar issues in the future.  May be asked to coach staff on unusual or complex member issues that require on-the-spot response that staff are unable to address independently.  Exhibit a positive attitude while providing encouragement and support to staff.  May be asked to assume leadership on special work projects.
• Other duties as assigned

Qualifications – what you need to perform the job

Education, Certification and Licensure

• Required: High School Degree or equivalent
• Preferred: Bachelor’s degree preferred or equivalent relevant work experience.

Experience (minimum years required):

• Required: 2-4 years of Member Experience team experience; or commensurate experience required. Solid knowledge of Plan products & processes
• Preferred:

Skill Requirements

• Proficient keyboard skills and excellent verbal and written communication skills.
• Requires strong organizational skills as well as the ability to research and respond to high volume of issues via the phone, e-mail, or in writing in a consistent and professional manner.
• Basic math, grammar, and spelling skills are required.
• Knowledge of medical terminology is preferred.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.