The customer advocate 1, under general supervision, communicates to members and providers policy and procedures and services of the health plan (plan), and handles any complaints concerning the plan by the membershipThis position works on the members behalf to resolve any issues and concerns by going the extra mile, when needed.
Essential functions of the role
Under general supervision, communicates to members and providers policies, procedures and services of the plan to ensure complete understanding of the planAssists members with access to the plan system, and helps members choose an appropriate physician, and assist with appointments.
Must adhere to call handling goals of 80% of calls answered within 30 secondsSupports and adheres to call abandonment rate of less than five percent (5%) with average hold time not to exceed 2 minutes based on regulatory requirementsWithin 60 days of employment on the floor, must meet monthly quality goal of ninety-two percent (92%) or greater based on two percent (2%) of calls monitoredSupports and meets schedule adherence goals based on department policy successful completion of competency testing following initial advocate training.
Serves as a primary contact for benefits, claims status and simple drug inquires for individual plans with working knowledge of other products, based on first contact resolution guidelinesVerifies demographic information on all inquiries and updates the plan system.
Assists members with concerns and actively works toward a resolution before the concern escalates to a complaint.
Accesses appropriate sources to obtain benefit information requested by member and providers.
Acts as liaison between members, providers and billing offices, with follow through to resolve issues.
Accurately documents phone log records for each inquiry with appropriate messaging based on department standards.
Key success factors
Requires successful completion of competency testing following initial advocate training.
Must successfully complete customer service training and successfully pass competency exam to maintain csa position.
Must successfully complete spelling, grammar and basic computer skills testing during job interview.
Must be proficient in typing and basic computer skills.
Perform well in a fast-paced, stressful routine work environment.
Must possess good phone etiquette and uses effective communication skills (both verbal and written).
Must be familiar with policies, procedures and new products offered by marketing and completes training as required.
Must be able to multi-task.
Must be knowledgeable in public relations with a diverse customer base.
Must be able to problem solve and act as advocate for the customer.
Our competitive benefits package includes the following
Immediate eligibility for health and welfare benefits
401(k) savings plan with dollar-for-dollar match up to 5%
Pto accrual beginning day 1
Note: benefits may vary based upon position type and/or level
- education - h.sDiploma/ged equivalent
- experience - 1 year of experience