Customer Service Specialist

Title: Customer Service Advocate

Location: 100% Remote(Candidates must reside in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas)

Terms of Employment

• W2 Contract-to-Hire, 5 Months

• This position is 100% remote. Candidates must reside in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas.

• These individuals will be provided with roughly four-to-six weeks of training prior to working operationally. Training starts between 8:00-8:30 AM and ends at 5:30 PM.

• Shifts are as follows: 8:00 AM – 5:00 PM (ET); 8:30 AM – 6:00 PM (ET); 9:00 AM – 6:30 PM (ET); 11:00 AM – 8:00 PM (ET). Candidates should be comfortable considering these shifts.

• There are weekend hours during open enrollment season – October 15-March 31. Between April 1-October 14, there are no weekend hours. Candidates should be comfortable with working weekends.

Overview

Our client is seeking Customer Service Advocates to be responsible for answering member and provider inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. As a Customer Service Advocate, you will proactively provide information and education to providers, as appropriate. You will provide basic technical assistance and troubleshooting guidance for digital and electronic applications.

Responsibilities include:

• Provides first- level problem resolution to member, provider & broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolve issues based on applicable policies and procedures.

• Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable.

• Appropriately 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 by effectively utilizing the business areas enrollment/inquiry tracking system & processes.

• Participates in ongoing education related to new services, industry topics, and skills.

Required Skills & Experience

• High School Diploma or GED and 3+ years of inbound call center customer service experience strictly within a healthcare or medical insurance environment.

• Minimum of 1 year of experience working in a high-volume, inbound healthcare or insurance call center.

• Demonstrated experience handling complex health insurance topics such as medical claims, benefits verification, eligibility, or pre-authorizations.

• Proven capability to handle occasional outbound follow-up calls professionally.

• Comfortable working in Microsoft Office at a basic level – namely using Word and Excel.

• Strong and accurate typing skills to document information from providers while on the phone.

• Comfortable meeting/exceeding key performance indicators (KPIs) based on set service level agreements (SLAs).

• Demonstrated skills as an empathetic and compassionate communicator.

• Ability to quickly gain customer trust and confidence.

Preferred Qualifications

• Prior experience dealing specifically with Medicaid, D-SNP, or Medicare Advantage PPO guidelines.