JOB SUMMARY

The Customer Advocate 1, under general supervision, communicates to Members and Providers policy and procedures and services of the Health Plan (Plan), and handles any complaints concerning the Plan by the membership. This position works on the Members behalf to resolve any issues and concerns by going the extra mile, when needed.

QUALIFICATIONS

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - 1 Year of Experience

• Under general supervision, communicates to Members and Providers policies, procedures and services of the Plan to ensure complete knowledge of the Plan. Helps Members with access to the Plan system, and helps members pick an appropriate physician, and help with appointments.
• Must adhere to call handling goals of 80% of calls answered within 30 seconds. Helps and adheres to call abandonment rate of less than five percent (5%) with average hold time not to exceed 2 minutes based on regulatory requirements. Within 60 days of employment on the floor, must meet monthly quality goal of ninety-two percent (92%) or greater based on two percent (2%) of calls monitored. Helps and meets schedule adherence goals based on department policy successful completion of proficiency testing following initial Advocate training.
• Serves as a primary contact for benefits, claims status and simple drug inquires for Personal Plans with working knowledge of other products, based on first contact resolution guidelines. Verifies demographic information on all inquiries and updates the Plan system.
• Helps Members with concerns and effectively works toward a resolution before the concern escalates to a complaint.
• Accesses appropriate sources to obtain benefit information requested by Member and Providers.
• Acts as liaison between Members, Providers and billing offices, with follow through to resolve issues.
• Accurately documents phone log records for each inquiry with appropriate messaging based on department standards.