Advanta Advocate-Customer Care Agent

MedImpact•Tempe, AZ

3d•Onsite

About The Position

Works as a member of the Advanta Advocate team, working directly with enrolled employees (members) on their medical health insurance plans. Advocates negotiate with facilities and providers to help obtain the best care at the best price for members’ health needs. The role interacts with internal and external customers to provide and obtain information and ensure outstanding service and quality. It works under general supervision, relying on instructions, work-process guidelines, policies and procedures, and company knowledge and experience. 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 business needs require. No travel is required, although attendance at local conferences and meetings may be required.

Requirements

GED or high school diploma and 2 or more 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 understanding to written, oral, or diagrammed instructions and solve problems involving several concrete variables in standardized situations.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume, and apply basic algebra and geometry.
Ability to present information effectively in one-on-one and small-group settings to customers, clients, and employees.
Ability to meet the physical demands of the position, including regularly sitting, talking or hearing, standing, walking, using hands to handle or feel objects, and reaching; occasional lifting or moving of up to 25 pounds.
Ability to work on-site in Tempe; remote work is not an option.
Ability to work overtime from time to time and work nights, weekends, or holidays as required by business needs.

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, identify appropriate actions, resolve issues, gather and provide information, and offer assistance.
Negotiate with facilities and providers and deliver 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 action or assistance from other organizational areas when necessary.
Educate external customers and members about the company’s roles and responsibilities, including override guidelines, benefit plans, prior authorization requirements, grievance and appeal processes, and other plan-specific functions.
Follow up with customers and members as appropriate to ensure satisfaction and timely responses to requests.
Listen to upset customers and members, diffuse concerns, and provide positive solutions.
Represent the company positively by following established processes, procedures, and guidelines.
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.