Demonstrated skills as an empathetic and compassionate communicator
Call Center experience, Medical Insurance background (a plus but not required)
Requirements:
Answer member, provider, and broker inquiries about product information, benefits, claims resolution, eligibility, and billing questions in a call center environment
Proactively provide information and education to members, providers, and brokers about health, financial, and self-service programs
Provide basic technical assistance and troubleshooting guidance for digital and electronic applications
Document all client interactions according to established procedures
Job description
Our client, a Health Insurance company, is looking for a Customer Service Advocate II for their Remote location.
Responsibilities:
Responsible for answering members, provider & broker inquiries pertaining to 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.
35% Provides first- level problem resolution to member, provider and broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures.
20% Uses knowledge of products or services by collecting and the contractual provisions that govern administration to provide customer information service and analyzing education, to interpret contractual language to the customer needs for the purpose of providing 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.
Appropriate documents all client interactions according to established
15% Prioritize workflow & multitask efficiently in a fast-paced environment while using multiple skill sets with demonstrated proficiency.
15% Delivers accurate information to customers in accordance with performance goals and objectives.
10% Maintains customer advocate records by identifying underlying customer needs and guiding them to appropriate resources or programs updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes.
5% Participates in system as needed. Ongoing education related to new services, industry topics, and skills
Requirements:
High School Diploma or GED
3 years of customer service experience
Knowledge, Skills and Abilities (KSAs):
Demonstrated skills as an empathetic and compassionate communicator., Advanced
Ability to quickly gain customer trust and confidence., Advanced
Demonstrated PC navigation and data entry skills., Advanced
Strong interpersonal communication skills., Advanced
Good oral and written communication skills., Advanced
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
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.
Call Center experience, Medical Insurance background (a plus but not required)
