Independent Member Advocate - Hybrid (Medfield, MA)

Digital Insurance•Medfield, MA

3d•Hybrid

About The Position

Employee Benefits is the core of our business and at our heart we are a people-focused organization. Every day, we help over 100,000 employers give their employees peace of mind by providing health, pharmacy, long and short-term disability, vision, dental and other insurance solutions. What makes us unique is that we can surround our clients with more services and more technology-based tools and a team of advisors that simply cares more than anyone else. If you want a career giving people the reassurance that they can have access to the health care they need for themselves and their loved ones, join OneDigital.

Requirements

High school diploma or equivalent.
Basic customer service skills with a friendly, professional demeanor
Strong communication and interpersonal skills.
Willingness to learn and adapt to new processes
Ability to thrive in a fast-paced environment
Reliability, punctuality, and the ability to manage time efficiently while handling multiple duties at once
6 months to 2 Years of customer service experience in group benefits: 2 years is preferred
Knowledge of healthcare benefits and the ability to communicate information to members
Proficient in Microsoft Outlook, Word, Excel and PowerPoint

Responsibilities

Manage high volume of incoming calls and emails explaining healthcare plan benefits, assisting members with locating in-network physicians/facilities, educating members on available self-help resources maintaining 90% or above in answered calls.
Outbound calls to provide eligibility/benefit information to healthcare service providers, advocating for member with health care provider, pharmacy, insurance carrier to resolve problems quickly and efficiently.
Respond to basic inquiries on Flex Spending Accounts/Commuter Benefits, ancillary benefits, COBRA and Medicare
Troubleshoot debit card declines and online portal access
Identify eligibility or claims errors, and collaborate with other departments for correction to ensure a seamless member experience
Review book of business prior to renewal to revise client/member contact sheets and renewal materials to include Benefits Guide, benefit summaries, medical funding sheets in conjunction with built plans
Verify eligibility and benefits for healthcare providers and inquiries regarding claim payments and remittances.
Document call and email interactions according to standard procedure
Respond to incoming email inquiries efficiently and timely with follow-ups according to standard procedure
Escalate complex issues to higher-level representatives when necessary
Build and retain relationships with plan members and clients
Maintain 3 or above on CSAT Phone surveys