Customer Advocate I
About The Position
Under supervision, the Customer Advocate works in a call center responding promptly, accurately, and objectively to telephone and written inquiries from health plan members and physicians. The role includes researching questions and handling a high volume of inbound and outbound calls about health plan benefits, claim statuses, eligibility, and provider networks. The posting estimates that approximately 85% to 90% of scheduled work time is spent on the phone, depending on the section and business needs. The Customer Advocate monitors calls at an on-site call center and helps members and providers resolve issues, including by analyzing inquiries, anticipating needs, taking next steps, and initiating and coding adjustment transactions. The role involves secure communications with providers, families, and patients in compliance with HIPAA, and maintaining confidentiality of company business. Mandatory onsite training lasts eight weeks, with no exceptions. Employees assigned to a Customer Service Hub may also be required to return for onsite training for up to 18 months. Relocation assistance and sponsorship are not available.
Requirements
- High school diploma or GED.
- At least 6 months of customer service experience or 6 months of experience in an office environment.
- Data entry and/or typing experience.
- Proficient computer skills and ability to navigate various computer applications.
- Interpersonal, verbal, and written communication skills.
- Analytical, organizational, independent decision-making, and problem-solving skills.
- Ability to spend approximately 90% of scheduled time on the phone according to business needs.
- Ability to sit for long periods with scheduled breaks.
Nice To Haves
- At least 1 year of customer service and internal sales experience.
- At least 9 months of customer service experience.
- Experience with billing, working in a medical office, or hospital customer service.
- Experience working with different lines of business, such as CDHP, Medicare, Wellness, and Disease Management.
- Knowledge of medical terminology and anatomy.
- Proven ability to learn quickly and adapt to change.
- Referral preference may be given to applicants able to take and meet testing criteria.
Responsibilities
- Respond promptly, accurately, and objectively to member and physician telephone and written inquiries.
- Research inquiries and handle a high volume of inbound and outbound calls concerning health plan benefits, claim statuses, eligibility, and provider networks.
- Analyze member or provider inquiries, anticipate needs, and take proactive steps to complete requests.
- Initiate and code adjustment transactions to correct and resolve inquiries.
- Help customers navigate healthcare complexity, resolve issues, and meet their needs on the first interaction.
- Collaborate with providers, families, and patients through secure communications in compliance with HIPAA.
- Maintain complete confidentiality of company business.
- Spend approximately 85% to 90% of scheduled work time on the phone, according to business needs.
Benefits
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- Paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
- Other incentives
- Annual incentive bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
