[Hiring] Bilingual Member Service Advocate @SCAN Health Insurance

Role Description

Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services. Ensures member satisfaction by providing superior customer service and willingness to help at all times while maintaining a professional demeanor.

• Provides quality customer service by applying SCAN Five Service Principles.
• Educates members, family, providers, and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email, or telephonically.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution.
• Escalates appropriate member issues to management or other departments as required.
• Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance.
• Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims, and all other issues following departmental policies and procedures and job aids.
• Takes ownership of the issue, focusing on providing solutions and options for members, as necessary through resolution of member issues.
• Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely, and accurate fashion; coordinates resolution with providers and other departments as needed.
• Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention.
• Follows policies and procedures and job aids in order to maintain efficient and compliant operations; communicates suggestions for improvement and efficiencies to management.
• Identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to SCAN Health Plan operations, as documented in company policies and procedures.
• Follows all HIPAA requirements.
• Documents transactions by completing applicable member forms and summarizing actions taken in the appropriate computer system and following standards set by the department or by other authorized individuals.
• Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development.
• Contributes to team effort by accomplishing related results as needed.
• Actively supports the achievement of SCAN’s Vision and Goals.

Qualifications

• 1-2 years call center or related customer service experience, required.
• 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans preferred.
• Experience in the healthcare, insurance, or pharmacy industry highly desirable.
• Ability to maintain calm demeanor at all times, including during highly charged situations.
• Data entry and general computer skills (word processing, e-mail) required.
• Effective communication (oral and written) skills.
• Professional/pleasant telephone manner required.
• Ability to handle large call volume while providing excellent customer service at all times required.
• Demonstrated efficiency/effectiveness in an environment with a high call volume.

Benefits

• Base Pay Range: $20.00-$21.50
• Work Mode: Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO) - 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!