Customer Advocate I-6

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Job Description Summary :

The Customer Advocate position is responsible for responding to a variety of inquiries from members and their dependents, hospitals, providers, attorneys and agents. The incumbent will need to interpret multiple contracts in response to benefit and claim inquiries. Researches membership database and billing history to resolve membership issues.

Job Description

EACH DUTY AND RESPONSIBILITY MUST BE PERFORMED IN ACCORDANCE WITH INDIVIDUAL PERFORMANCE SCORECARD INQUIRY AND QUALITY STANDARDS.     

• Provides a high degree of customer service including receiving and responding to telephone calls, letters or walk-in customers.
• Educates and works with members at different health literacy levels with cultural sensitivity.
• Enters record of inquiries and related correspondence in computerized tracking system.
• Researches applicable medical policy and corporate, divisional, and department policies and procedures. Utilizes information, claims data, and membership records to resolve issues independently or with minimal assistance, when possible within first call
• Fully responsible for proactively maintaining knowledge based (i.e. start-up notes, emails, Blue Help updates, etc.)
• Maintains confidentiality of all regulated information in compliance with state and federal laws.
• Exemplifies professionalism by effectively using proper grammar and spelling when composing verbal and written correspondence that is customer centric, compliant, and adapted to audience.
• Recognizes trends or common issues and raises to leadership as necessary. Provides solution options as appropriate.
• Recognizes and uses time management techniques appropriately to manage competing projects and priorities to meet customer needs and deliver on commitments in a timely manner.
• Delivers positive customer and member experience on a consistent basis
• For FEP positions must complete additional FEP training program for FEP system and procedures.
• Provides resolution with a service level that ensures members and customers feel valued and understood

Minimum Qualifications

• High school diploma or general education degree (GED).

•  2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience.
• Advanced Keyboarding Knowledge
• Intermediate knowledge of Microsoft Office

Preferred Qualifiations

• Associates degree from college or technical school.
• Previous experience with on-line customer service applications
• Medical terminology and ICD/CPT coding knowledge is preferred.