Customer Experience Advocate

South Florida Community Care Network•Sunrise, FL

13d•Hybrid

About The Position

The Customer Experience Advocate provides professional, responsive, and compassionate service to members and providers through telephone and other communication channels. This frontline role addresses questions about health plan benefits, eligibility, claims, referrals, authorizations, and other member or provider concerns. The advocate researches and resolves issues when possible, shares accurate information and education, and coordinates with internal departments to support timely resolution and a positive customer experience. The role includes answering calls, documenting interactions, handling complaints, researching concerns, educating members about care gaps, coordinating care, completing new-member onboarding, and identifying and escalating member retention risks. The position requires maintaining confidentiality under HIPAA guidelines and may include other job-related duties assigned by a supervisor or management. The position follows a hybrid work schedule that the company may change based on business needs. The schedule is Monday through Friday, day shift. The work environment may include work inside or outside the office and travel to other offices, as well as domestic travel. The noise level is usually moderate. Selected candidates must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

Requirements

High school diploma or GED.
Bilingual in English and Spanish.
Knowledge of word processing, spreadsheet, internet, and other computer applications.
Excellent verbal and written communication and active listening skills.
Strong customer service and problem-solving skills, including the ability to research and resolve customer concerns.
Ability to handle multiple systems and tasks simultaneously while maintaining accuracy.
Strong attention to detail and ability to accurately document customer interactions and information.
Ability to remain professional and composed when handling complaints, sensitive situations, or challenging interactions.
Ability to establish and maintain effective working relationships with members, providers, internal departments, and other stakeholders.
Ability to understand and communicate information clearly while maintaining confidentiality and HIPAA requirements.
Ability to work independently and collaborate effectively within a team.

Nice To Haves

Experience in healthcare, health insurance, managed care, or a related healthcare environment.
Experience handling customer or member inquiries, complaints, benefits, eligibility, referrals, authorizations, or other healthcare-related services.
Experience with Epic or other healthcare information systems.
At least two years of customer service experience.

Responsibilities

Understand the managed care philosophy and the company’s products.
Receive and respond to member and provider calls and inquiries about enrollment, claims, benefit interpretation, referrals, and authorizations for medical care.
Answer calls pleasantly and courteously within 30 seconds.
Receive, record, and resolve member complaints and problems.
Access member information through multiple computer systems and accurately document member and provider contacts.
Ensure members receive accurate and complete information.
Communicate professionally with members, providers, and state agencies.
Screen calls and direct them to the appropriate person or department as necessary.
Act as a liaison between members, physicians, and the health plan.
Research member concerns and attempt to resolve issues during calls.
Coordinate with other departments to address member and provider issues.
Prepare documentation and reports for review by the Customer Services Director and Supervisor.
Maintain confidentiality in accordance with HIPAA guidelines.
Proactively educate members about care gaps and coordinate care to assist members.
Identify and proactively escalate member retention risks.
Complete onboarding for new members.
Perform other job-related duties assigned by a supervisor or management.