Customer Experience Advocate

South Florida Community Care Network • Sunrise, FL

5d • Hybrid

About The Position

Responsible for providing professional, responsive, and compassionate customer service to members and providers through telephone and other communication channels. This position serves as a front-line resource for questions related to health plan benefits, eligibility, claims, referrals, authorizations, and other member or provider concerns. The Customer Experience Advocate researches and resolves issues, when possible, provides accurate information and education, and coordinates with internal departments to support timely resolution and a positive customer experience.

Requirements

• High school diploma or general education degree (GED).
• Bilingual English/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, with 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 while also collaborating effectively within a team.

Nice To Haves

• Experience in healthcare, health insurance, managed care, or related healthcare environment
• Experience working with customer/member inquiries, complaints, benefits, eligibility, referrals, authorizations, or other healthcare-related services
• Experience with Epic or other healthcare information systems
• Minimum of two (2) years of customer service experience

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.
• Answer 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.
• Research 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.
• Proactively educate members regarding care gaps.
• Coordinate care to assist members
• Identifies and proactively escalates member retention risks.
• Completes onboarding of new members

Benefits

• We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique.
• We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED