Member Services Advocate

Convey Health Solutions•Fort Lauderdale, FL

2d•Onsite

About The Position

We at Convey Health Solutions focus on building specific technologies and services that can uniquely meet the needs of government-sponsored health plans. We provide member management solutions for the rapidly changing healthcare world. We are looking for people to help be a part of those solutions. As a Member Services Advocate, you will be a part of a team that transforms customer service into customer care by delivering an amazing experience. You will assist beneficiaries with a wide range of critical services which include but not limited to updating account information, providing plan information and resolving issues with utilization of the plan. Qualified candidates will have a strong desire to help people, strong customer care skills, attention to detail and be very organized.

Requirements

Highschool Diploma is required
Minimum 2 years working in a fast-paced high volume call center environment, retail customer service or hospitality.

Nice To Haves

Associate Degree preferable
Healthcare experience is a plus

Responsibilities

Update account information such as billing options and changes of address or phone numbers.
Research premium billing discrepancies and prescription claims processed.
Educate beneficiaries on how the plan works, including benefits, cost sharing and levels of coverage.
Submit mail requests for beneficiaries such as ID cards and formularies.
Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why.
Displays positive demeanor, technical accuracy and conformity to company policies.
Understands CMS Guidance and ensures applicable exhibits are being mailed per CMS Guidance.
Ensure HIPAA regulations are maintained within the immediate environment.
Responsible for concise and detailed notations as it pertains to member records.
Handles outbound calls for purposes of validating information.
Handles inbound calls by assisting members with a high level of accuracy and efficiency.
Escalates any member issues to management as necessary.
Responsible for maintaining a high level of call quality as set by client standards, which includes a 95% quality score and answering 80-85% of calls within 30 sec or less.
Communicate with coworkers, management and customers in a courteous/professional manner.
Conform with and abide by all regulations, policies, work procedures and instructions.
Respond promptly when returning telephone calls and replying to correspondence.
Act and behave in a professional manner to reflect a positive image of the company.
Meet average QA score of 95%
Comply with attendance guidelines of 98%
Schedule adherence of 90% or higher
Maintain AHT below certain standards