Customer Experience Advocate

South Florida Community Care Network•Sunrise, FL

5d•Hybrid

About The Position

Responsible for communicating with physicians and patients regarding plan benefits and eligibility. This position emphasizes member education, customer service and front-line problem solving.

Requirements

High school diploma or general education degree (GED)
Candidates must be bilingual in English and Spanish (speaking only) - required
Two to four years related experience and/or training; or equivalent combination of education and experience.
Knowledge of word processing software, spreadsheet software, internet software
Candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

Nice To Haves

Epic software (preferred)

Responsibilities

Thoroughly understands the managed care philosophy and the company’s products.
Receives and responds to member and provider phone calls/inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
Receives, records, and resolves member complaints and problems.
Answers calls in a pleasant and courteous manner within 30 seconds.
Routinely accesses member information via multiple computer systems.
Accurately documents member and provider contacts on the computer system.
Responsible for ensuring that members receive accurate and complete information.
Communicates effectively and professionally with members, providers, and state agencies.
Screens telephone calls and directs to the appropriate area or person as necessary.
Acts as a liaison between members, physicians, and health plan.
Researches member concerns and attempts to resolve issue during call.
Works in coordination with other departments concerning member and provider issues.
Prepares documentation and reports for review by the Customer Services Director and Supervisor.
Maintains confidentiality per HIPAA guidelines.
Employees will be required to perform any other job-related duties assigned by their supervisor or management.