[Hiring] Customer Service Advocate I @CareFirst

Role Description

Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications.

• Provides first-level problem resolution to member, provider & broker inquiries via telephone and/or written correspondence by gathering and researching information.
• Examines claim submissions verifying claim and system accuracy as well as liability.
• Validates customer understanding of information and resolves issues based on applicable policies and procedures.
• Uses knowledge of products and contractual provisions to provide customer service and education.
• Interprets contractual language to the customer for the purpose of providing benefit utilization and limitations.
• Determines the need for managed care initiatives and administers all types of services to customers.
• Documents all client interactions according to established departmental procedures.
• Delivers accurate information to customers in accordance with performance goals and objectives.
• Maintains customer records by updating account information using the business areas enrollment/inquiry tracking system & processes.
• Participates in ongoing education related to new services, industry topics, and skills.

Qualifications

• Education Level: High School Diploma or GED.
• Experience: Less than one year customer service experience.
• Preferred Qualifications: Less than 1 year experience in a call center customer service role or experience with medical or insurance terminology.
• Knowledge, Skills and Abilities (KSAs):
• Successful completion of the training provided.
• 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.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer.

Requirements

• Salary Range: $32,256 - $59,136
• Must be eligible to work in the U.S. without Sponsorship.

Benefits

• Comprehensive benefits package.
• Various incentive programs/plans.
• 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).