Customer Advocate I

Role Overview

• Responsible for responding to a variety of inquiries from members and their dependents, hospitals, providers, attorneys and agents
• Interpret multiple contracts in response to benefit and claim inquiries
• Research membership database and billing history to resolve membership issues
• Provides a high degree of customer service including receiving and responding to telephone calls, letters or walk-in customers
• Educates and works with members at different health literacy levels with cultural sensitivity
• Enters record of inquiries and related correspondence in computerized tracking system
• Researches applicable medical policy and corporate, divisional, and department policies and procedures
• Utilizes information, claims data, and membership records to resolve issues independently or with minimal assistance
• Fully responsible for proactively maintaining knowledge based (i.e. start-up notes, emails, Blue Help updates, etc.)
• Maintains confidentiality of all regulated information in compliance with state and federal laws
• Exemplifies professionalism by effectively using proper grammar and spelling when composing verbal and written correspondence that is customer centric, compliant, and adapted to audience
• Recognizes trends or common issues and raises to leadership as necessary
• Provides solution options as appropriate
• Recognizes and uses time management techniques appropriately to manage competing projects and priorities to meet customer needs and deliver on commitments in a timely manner
• Delivers positive customer and member experience on a consistent basis
• For FEP positions must complete additional FEP training program for FEP system and procedures

Requirements

• High school diploma or general education degree (GED)
• 2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience
• Advanced Keyboarding Knowledge
• Intermediate knowledge of Microsoft Office
• Must have previous experience taking provider calls, preferably BlueCard
• Associates degree from college or technical school (preferred)
• Previous experience with on-line customer service applications (preferred)
• Medical terminology and ICD/CPT coding knowledge (preferred)
• Experience taking Blue KC member calls (preferred)

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program