Customer Care Advocate

Zenith American Solutions•Alameda, CA

About The Position

The Customer Care Advocate provides customer service to participants, beneficiaries, union locals, and providers regarding eligibility, benefits, and claims status. The role has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) based on the job description and role. The position maintains knowledge of assigned plans and applies that knowledge when responding to and documenting telephone and written inquiries. It also performs administrative tasks related to retirement and health and welfare benefits, including processing forms and correspondence, enrollments, member information updates, and regulatory communications. The advocate initiates and follows up on requests for adjustments and researches and resolves complex or technical issues. This job description is not a comprehensive listing of all duties, and responsibilities and activities may change at any time with or without notice.

Requirements

High school diploma or GED.
At least 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, verbally and in writing.
Solid organizational skills, attention to detail, 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.

Responsibilities

Maintain current knowledge of assigned plans and apply that knowledge in job functions.
Provide written, verbal, or face-to-face customer service by responding to and documenting telephone and written inquiries in accordance with plan benefits.
Update files, including documenting system notes about conversations or actions taken.
Process and/or send mailers or required forms requested by members.
Process and/or send correspondence related to member or claims status.
Process enrollments and update member information in applicable systems.
Distribute communications related to regulatory requirements.
Initiate Action Requests to appropriate departments for necessary claims, retirement, and/or eligibility adjustments, and follow up to ensure completion.
Research and resolve complex and technical issues and irregularities.
Perform other duties as assigned.