JOB SUMMARY:
The Customer Service Advocate II is a position within the Community Health Choice Customer Service Center that is primarily responsible for, but not limited to responding to incoming hotline inquiries as they relate to benefits and eligibility verification, claim status (with the ability to identify if a claim requires reconsideration), authorization status, and complaints, accurate documentation recording of all calls; effective follow-up of calls, as required; and proper electronic routing with effective documentation skills while maintaining confidentiality per HIPAA guidelines.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Essential Functions
40% Ability to respond effectively and timely to inbound calls regarding benefits and eligibility, claims processing status, and authorization status. For those calls pertaining to claims inquiry, the Customer Service Advocate will effectively handle questions and document transactions in the proper claim modules, provide first call resolution, when possible, by identifying problems and providing solutions, submitting adjustment reconsideration request when appropriate, and identify and track trends and report them to the appropriate manager for resolution.
40% Maintains a working knowledge of the claim systems and accurately enters the required information into the designated Customer Relationship Management system (CRM), while adhering to departmental and organizational policies and procedures.
Marginal Functions
15% Maintains a professional behavior and exhibit excellent interpersonal skills.
5% Other Duties as assigned
Reports to Position Title: Customer Svc Center Supervisor
Employees Supervised Titles: N/A
MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure:
- High School diploma or GED or equivalent
Work Experience (Years and Area):
- 2 years relevant work experience of which: 1 (one) year of health care / plan, or other related experience.
- Cross-functionality in Claims and Authorization Status, Benefits and Eligibility. for at least two (2) lines of business for all Customer calls and/or electronic communication.
Management Experience (Years and Area): N/A
Software Proficiencies: Microsoft Office (Word, Excel, Outlook)
Other: Ability to work independently under minimal direction. Moderate to advanced
computer knowledge required.
COMPETENCIES
Organizational Core Competencies: All employees are responsible for understanding and demonstrating Community Health Choice core competencies:
Customer Focus
Reliability and Dependability
Honesty & Integrity
Achievement Orientation
Change Management
Team Work
Problem Analysis
Attention to Detail
Analytical Thinking
Responding Sensitively
Above Average Verbal
Bilingual: Spanish or threshold language preferred
INTERPERSONAL SKILLS
Ensures all interactions are conducive to developing and maintaining a cooperative and productive working environment (both internally and externally).
Maintains self-control and conducts activities in non-adversarial manner
