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Customer Service Advocate
4 months ago
* Customer Service Advocate must demonstrate proficiency and consistently "meet or "exceed performance expectations in all of the requirements for the Sr. Customer Service Advisor. A primary function for Customer Service Advocate is to demonstrate the ability to perform at multiple service functions at a higher level with the higher degree of proficiency, as well as the ability to demonstrate a higher level of competence at their cross functional ability. Incumbent should perform in another area of service expertise to include claims processing of adjustments, claims adjudication; complex claims adjustments, processing of emails and written correspondence. Additionally, the incumbent must be a product specific subject matter expert and should demonstrate proficiency in training, coaching and function as a subject matter expert and as a motivational resource for the Customer Service Advisor and Sr. Customer Service Advisor associates. The scope of this position is focused on more strategic and long term approaches to improving the overall performance and the development of both the associate staff and department
* 30% Provides effective support in coaching, training and the motivation of Customer Service Advisor and Sr. Customer Service Advisor associates. Assists and supports the department and team with maintaining cases, adjustments and correspondence inventories using proven best practices. Development of clinics and workshops to assist associate staff with meeting the inventory metrics.
* 30% Functions as a subject matter expert with increased visibility at meetings, conference calls and projects as a representative stakeholder in the outcome of corporate, departmental and divisional initiatives.
* 20% Demonstrates proven ability to perform all service functions at a higher level with the highest degree of proficiency, as well as the ability to achieve a higher level of competence at their cross functional ability to perform in another area of service expertise to include claims adjudication, complex claims adjustments, processing of email and written correspondence and handling of walk-in clients.
* 20% Use knowledge of products and the contractual provisions that govern administration to provide effective customer service and education, to interpret contractual language to client for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of service to a client within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments. Appropriate documentation of all client interactions according to established departmental procedures.
* Achieves the highest level or better in customer satisfaction measures, divisional and corporate performance metrics established by MTM, ITS, NCQA, accounting audits, performance guarantees, performance contracts and service level agreements. All Service personnel may be required to dedicate up to 100% on of their productive time on phone coverage as deemed necessary by the department
Requirements:
* Required: High School diploma or equivalent. Position requires performance at "meets standards or above for 5+ years of customer service and/or claims adjudication. Healthcare and/or Insurance industry experience is a must. The incumbent must be cross trained between service and claims adjustment with the ability to handle varied and more complex issues
* Abilities and Skills: Proficiency in use of FLEXX and/or NASCO automated systems, PC or CRT. Excellent oral and written communication skills, time management and organizational management skills. Strong analytical abilities, problem-solving skills and the ability to work independently in a fast paced work environment. Demonstrated success in the training and development of associate staff and department through effective team skills, leadership skills, quality improvement, productivity, business flexibility and customer retention
* Preferred: 2-4 years of college in Business or other related field. Bilingual in Spanish, etc. is a bonus
