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Essential Functions

• Provides first- level problem resolution to member, provider and broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures.
• Uses knowledge of products or services by collecting and the contractual provisions that govern administration to provide customer information service and analyzing education, to interpret contractual language to the customer needs for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. Appropriately documents all client interactions according to established departmental procedures.
• Prioritize workflow & multitask efficiently in a fast-paced environment while using multiple skill sets with demonstrated proficiency.
• Delivers accurate information to customers in accordance with performance goals and objectives.
• Maintains customer advocate records by identifying underlying customer needs and guiding them to appropriate resources or programs updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes.
• Participates in system testing as needed and ongoing education related to new services, industry topics, and skills.

Qualifications

Education Level: High School Diploma or GED.

Experience: 3 years customer service experience.

Preferred Qualifications

• 3 years experience in a call center customer service role or experience with medical or insurance terminology.

Knowledge, Skills And Abilities (KSAs)

• Demonstrated skills as an empathetic and compassionate communicator.
• Ability to quickly gain customer trust and confidence.
• Demonstrated PC navigation and data entry skills.
• Strong interpersonal communication skills.
• Good oral and written communication skills.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Customer Service Advocate II - MD Medicare (Remote)