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) as required by the job description and role. The position is in the Customer Care department, is non-exempt, and is listed as Grade 3 with 40 hours per week. The advocate maintains knowledge of assigned benefit plans and applies that knowledge when responding to customer inquiries. The role provides written, verbal, or face-to-face service; documents inquiries and actions; maintains member files; and performs administrative tasks related to retirement and health and welfare benefits. It also coordinates requests for adjustments with other departments and follows up on those requests. The position may involve researching and resolving complex or technical issues and irregularities. Zenith American Solutions describes itself as the largest independent Third Party Administrator in the United States, operating more than 44 offices nationwide. The company offers health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off, and growth opportunities.

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 a team-player mentality.
Highly developed sense of integrity and commitment to customer satisfaction.
Ability to communicate clearly and professionally, verbally and in writing.
Solid organization skills, strong 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 effectively apply that knowledge in job functions.
Provide written, verbal, or face-to-face customer service to participants, beneficiaries, union locals, and providers.
Respond to and document telephone and written inquiries in accordance with applicable plan benefits.
Update files, including recording system notes about conversations and actions taken.
Process and/or send mailers and 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.
Follow up to ensure Action Requests are completed successfully.
Research and resolve complex and technical issues and irregularities.
Perform other duties as assigned.