Advanta Advocate-Customer Care Agent

MedImpact Healthcare Systems, Inc.•Tempe, AZ

4d•$20 - $31•Onsite

About The Position

Works as a member of the Advanta Advocate team, assisting enrolled employees (members) with their medical health insurance plans. Advocates negotiate with facilities and providers to help members obtain appropriate care at the best price. The role interacts with internal and external customers to exchange information and provide outstanding service and quality. Work is performed under general supervision using instructions, process guidelines, policies, procedures, and company knowledge. This is a full-time, non-exempt position based on-site at the Tempe location; remote work is not an option. Typical hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. The role may require overtime and the ability to work nights, weekends, or holidays as needed. No travel is required, though attendance at local conferences and meetings may be required.

Requirements

GED or high school diploma and at least 2 years of experience, or an equivalent combination of education and experience.
Intermediate knowledge of Microsoft Office, including Word, Excel, and Outlook, and aptitude for learning new programs.
Experience with Windows-based database programs.
Ability to follow directions, work rules, procedures, and corporate policies; interact well with coworkers; accept constructive criticism; establish goals; and demonstrate initiative and commitment.
Ability to apply common-sense reasoning to written, oral, or diagrammatic instructions and resolve problems involving several concrete variables in standardized situations.
Ability to calculate figures and amounts including discounts, interest, commissions, proportions, percentages, area, circumference, and volume, and apply basic algebra and geometry concepts.
Ability to effectively present information in one-on-one and small-group situations to customers, clients, and coworkers.
Demonstrated competencies in composure, decision quality, organizational agility, problem solving, customer focus, drive for results, peer relations, time management, dealing with ambiguity, learning on the fly, and political savvy.
Ability to work on-site in Tempe.
Ability to work overtime and nights, weekends, or holidays as required.

Responsibilities

Coordinate and communicate pre- and post-service cases among operations, account management, sales, health services, stop loss, finance, clients, brokers, facilities, and members.
Respond promptly to member phone inquiries, determine appropriate actions, resolve issues, gather and provide information, and offer assistance.
Negotiate with facilities and providers and deliver care options to members while meeting or exceeding department performance standards.
Use company database programs to research and resolve issues involving benefit information, claims adjudication, eligibility verification, prior authorization, and other third-party administrator processes; request follow-up or assistance from other organizational areas as needed.
Educate members and other external customers about the company's roles and responsibilities, override guidelines, benefit plans, prior authorization requirements, grievance and appeal processes, and other plan-specific third-party administrator functions.
Follow up with members and customers as appropriate to ensure satisfaction and timely responses; listen to concerns and provide solutions to defuse difficult interactions.
Follow established processes, procedures, and guidelines while representing the company positively.
Support the department strategy by helping members have a positive health plan experience, find financial savings through provider and facility negotiations, and identify more cost-effective provider locations.