Senior Center - Member Advocate 171-1006

Community Care • Tulsa, OK

2d • Onsite

About The Position

Member Advocate II will provide exceptional service to our members that require customer service assistance in person at our Senior Center. Generally, the Member Advocate is called upon to listen to members, empathize with them and then work to solve issues they are unable to solve on their own regarding their health insurance or healthcare. The Advocates are called on to handle the more complex problems faced by our members or that may be reported to us by our various regulatory agencies. A Member Advocate II will also spend time on the phone with members assisting them with surveys, problem resolution, late payments and general customer service issues. Our Advocates are also licensed to assist members that wish to be join one of the CommunityCare health plans. Our advocates also provide support via outbound and inbound phone calls. Member Advocates also ensure members visiting the Senior Center for one of our many classes or educational seminars are assisted as needed.

Requirements

• Thorough knowledge of HMO plans, enrollment benefits, and claims.
• Exceptional customer service, active listening, verbal, and written communication skills.
• Demonstrated ability to relate and interact with all types of individuals.
• Demonstrated experience in providing professional courtesy, discretion, and confidentiality at all times.
• Excellent problem-solving, time management and decision-making skills.
• Flexible, ability to adapt to change.
• Proficiency with computers, especially with regards to Microsoft office applications.
• Highly organized and attentive to detail
• Successful completion of Health Care Sanctions background check.
• Licensed Life and Health insurance agent in the state of Oklahoma, or ability to obtain license within a reasonable amount of time from date of hire.
• Graduation from High School, bachelor’s degree in social work or similar profession preferred.
• Experience with face-to-face customer service.
• Three years previous customer service experience.

Nice To Haves

• Bilingual skills a plus.
• Working with the elderly or geriatrics preferred.
• Managed healthcare of insurance industry preferred.
• Prior claims examining experience preferred.

Responsibilities

• Use effective listening skills to understand the needs and complaints of the customer too offer them the best possible solution and ensuring the member feels supported and valued.
• Review, research, problem solve, and follow up with members regarding issues they may have for all lines of business whether received via the telephone, in person, Medicare Complaint Tracking Management System (CTM) or Health Insurance Casework System (HICS).
• Research and resolve issues related to Good Cause requests, potential PHI disclosures and PCP dismissals.
• Assist in making Late Payer calls as well as input and finalization of HRA surveys and commercial member satisfaction surveys.
• Assist with in-coming calls via the customer service queue as needed and assist members who present in the lobby needing assistance.
• Help current and potential members evaluate our various health plans and assist them with enrollment
• Able to perform as a team member while building positive relationships, trust reliability and excellence.
• Taking part in training and other learning opportunities to expand knowledge of company and position.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees