Description
Are you passionate about helping others and ensuring a positive experience? Join our team as a Customer Service Advocate, where you’ll be an essential part of our mission to provide outstanding support to our members. In this role, you’ll handle member service calls related to policy management, benefits, and claim inquiries, ensuring every interaction leaves our clients and members feeling valued and satisfied.
As a key player on our team, you’ll be responsible for accurately conveying important information to members, drawing on your solid understanding of healthcare claims, benefits, and policy processes. Familiarity with healthcare terminology, including ICD-9 and ICD-10 coding, is crucial to your success in this role.
Location
This is a remote position available to candidates located in Arizona, California, Idaho, Florida, Texas, New Jersey, Pennsylvania, Utah, and Washington.
Job Type
Full-Time, 100% Remote Position
Compensation
$17.00 per hour
Schedule
- Monday to Friday, 9:00 AM - 9:00 PM EST (you will be assigned a set schedule within this timeframe)
- Saturday, 10:00 AM - 2:00 PM EST
What We Offer
- A true work/life balance with a predictable schedule
- Paid training to set you up for success
- Comprehensive benefits package, including Medical, Dental, Life, Vision, HSA, and 401K
- Generous Paid Time Off (PTO)
Key Responsibilities
- Member and Provider Support: Manage inbound and outbound calls, offering clear, professional, and accurate responses to member and provider inquiries. You’ll provide details on membership options, benefits, and account status.
- Application Processing: Efficiently review, verify, and process membership applications, ensuring all information is accurate and complete.
- Data Entry and Management: Keep member information up-to-date in our CRM systems, maintaining data integrity across multiple client accounts.
- Multitasking: Juggle various responsibilities, including managing calls, processing paperwork, and updating databases, all without compromising on quality.
- Quality Assurance: Regularly audit member data to ensure compliance with client standards and industry regulations, swiftly addressing any discrepancies.
- Collaboration: Work closely with other teams, such as IT, customer service, and quality assurance, to resolve issues and enhance our service delivery.
- Process Improvement: Identify opportunities to streamline processes and contribute to initiatives that boost client satisfaction and operational efficiency.
Job Duties
- Handle Inbound Calls: Respond to calls from members, providers, and occasionally other health plans, providing updates on the status of authorization requests for both inpatient and outpatient services.
- Authorization Management: Manage re-direct requests and re-fax authorization documents as needed.
- Claims Denial Expertise: Provide clear explanations of claims and claims denials.
- Lines of Business: Support general membership inquiries, health plan providers, and more.
- Documentation and Compliance: Accurately document call interactions and ensure compliance with all relevant regulations and guidelines.
- Customer Service: Maintain a high level of professionalism in all interactions, resolving issues promptly and ensuring customer satisfaction.
Qualifications
- Education: High school diploma or equivalent.
- Technical Skills: Proficient in Microsoft Office Suite (Word, Excel, Outlook). Experience with CRM systems or membership databases is a plus. Strong typing and data entry skills, with the ability to manage multiple systems simultaneously.
Other Skills
- Attention to Detail: You have a keen eye for accuracy, ensuring data is consistent and error-free.
- Multitasking Ability: Proven ability to manage multiple tasks and priorities in a dynamic environment.
- Communication Skills: Excellent verbal and written communication skills, with the ability to clearly and confidently share information with members.
- Problem-Solving: Strong analytical skills, with a focus on quickly identifying and resolving issues.
- Customer Service Orientation: A passion for delivering top-notch service, aligned with our commitment to excellence.
Employment Type: Full-Time