Member Services Advocate at Convey Health Solutions

Mandaluyong, Metro Manila, Philippines -

Full Time

Start Date

Immediate

Expiry Date

25 May, 26

Salary

0.0

Posted On

24 Feb, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Care, Attention To Detail, Organization, Research, Communication, Policy Adherence, HIPAA Compliance, Call Quality Management, Efficiency, Problem Resolution

Industry

Hospitals and Health Care

Description

OVERVIEW/GENERAL PURPOSE OF POSITION As a Member Services Advocate, you will be a part of a team that transforms customer service into Customer Care by delivering an amazing experience. You will assist beneficiaries with a wide range of critical services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan. Qualified candidates will have a strong desire to help people with strong customer care skills, attention to detail, and highly organized. ESSENTIAL DUTIES AND RESPONSIBILITIES As our customers share concerns and provide us with valuable feedback, your ability to recognize and complete the steps necessary to meet their needs will leave a permanent, lasting impression of the passion you have for helping them be at their best. We make sure our customers are not alone when it comes to understanding their benefits and they will rely on you to advocate for them as you would your own family member. In addition to the keys to success identified above that you will bring with you to the team, you will need to demonstrate the following abilities: * Update account information such as billing options and changes of address or phone numbers. * Research premium billing discrepancies and prescription claims processed. * Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage. * Submit mail requests for beneficiaries such as ID cards and formularies. * Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why. * Displays positive demeanor, technical accuracy, and conformity to company policies. * Understands CMS Guidance and ensures applicable Exhibits are being mailed per CMS Guidance. * Ensure HIPAA regulations are maintained within the immediate environment. * Responsible for concise and detailed notations as it pertains to member records. * Handles outbound calls for purposes of validating information. * Handles inbound calls by assisting members with a high level of accuracy and efficiency. * Escalates any member issues to management as necessary. * Responsible for maintaining a high level of call quality as set by client standards, which includes a 95% quality score, and answering 80-85% of calls within 30sec or less * Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner. * Conform with and abide by all regulations, policies, work procedures and instructions. * Respond promptly when returning telephone calls and replying to correspondence and faxes. * Act, dress, and behave in a professional manner to reflect a positive image of the company. MONTHLY GOALS: * Meet average QA score of 95% * Comply with attendance guidelines of 98% * Schedule adherence of 90% or higher * Maintain AHT below certain standards QUALIFICATIONS: * At least HS/SHS Graduate * With at least 1 year BPO experience handling international voice accounts * Amenable to work onsite * Amenable to work at night Qualifications About Us Convey Health Solutions, together with Pareto Intelligence™, delivers a powerful combination of purpose-built technology, advanced analytics, and expert services to help health plans thrive in a complex, post--Affordable Care Act environment. As a trusted partner to Medicare and commercial payers, we provide scalable, compliant solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment, Stars performance, and member engagement. Pareto's deep analytics and financial intelligence complement Convey's operational expertise, enabling our clients to improve performance, reduce costs, and create better healthcare experiences for millions of Americans--especially seniors and vulnerable populations. Together, we help health plans scale smarter, grow stronger, and make healthcare work better for the people who need it most. Learn more at http://www.ConveyHealthSolutions.com

Responsibilities

The Member Services Advocate will assist beneficiaries with critical services such as updating account information, providing plan details, and resolving utilization issues, aiming to transform customer service into exceptional Customer Care. Key duties involve researching billing discrepancies, educating members on benefits, handling mail requests, and ensuring compliance with company policies and HIPAA regulations.