Customer Care Advocate

Zenith American Solutions•Glencoe, MD

4d•Onsite

About The Position

The Customer Care Advocate provides customer service to participants, beneficiaries, union locals, and providers regarding eligibility, benefits, and claims status. This role requires minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) as defined by the Job Description/Role. Key duties include maintaining current knowledge of assigned Plan(s) and applying it effectively, providing written, verbal, or face-to-face customer service by responding to and documenting inquiries, updating files with system notes, and performing tasks related to the administration of retirement and health and welfare benefits. This includes processing and sending mailers or forms, correspondence related to member or claims status, processing enrollments, updating member information, and distributing communications related to regulatory requirements. The role also involves initiating Action Requests for adjustments, following up on these requests, and researching/resolving complex issues. Other duties may be assigned.

Requirements

High school diploma or GED.
Six months of experience working in customer service, third-party administrator processing, or benefits administration.
Strong work ethic and team player mentality.
Highly developed sense of integrity and commitment to customer satisfaction.
Ability to communicate clearly and professionally, both verbally and in writing.
Solid organization skills with strong detail orientation and listening skills.
Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans and regulations.
Proficient computer skills including MS Office tools and applications.

Nice To Haves

Call center experience in benefits claims, billing, or eligibility.
Bilingual.

Responsibilities

Maintains current knowledge of assigned Plan(s) and effectively applies knowledge in all job functions.
Provides written, verbal, or face-to-face customer service by responding to and documenting telephone and written inquiries in accordance with various Plan(s) benefits.
Updates files, including documenting system notes of conversations or action taken.
Performs tasks associated with the administration of retirement and health and welfare benefits such as; Processing and/or sending mailers or required forms as requested by members.
Processing and/or sending correspondence related to member or claims status.
Processing enrollments and updating member information in applicable system(s).
Distributing communications related to regulatory requirements.
Initiates Action Requests to appropriate departments requesting adjustments to claims, retirement, and/or eligibility as necessary.
Follows up to ensure successful completion of Action Request.
Researches and resolves complex and technical issues and irregularities.
Performs other duties as assigned.