Customer Advocate I

Job content

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Minimum Salary Range

Job Summary

Under supervision, this position is responsible for working on the phone all day in a call center to assist members and physicians by responding to telephone and written inquiries in a prompt, accurate and objective manner. Duties include: conducting research; spends approximately 90% of the scheduled time on the phone according to business need.

Responsibilities

• Responsible for responding to telephone and/or written inquiries, working independently and consistently meeting customer needs. Receive, research, and process information from member or provider to determine needs/wants and ensure customer questions have been addressed. Determine appropriate action to be taken. Spend approximately 90% of the scheduled time on the phone according to business need. 2. Read and interpret contract language, gather appropriate documents, i.e. claim copies, claim history data, cancelled checks, on-line status, Explanation of Benefits (EOBs), and utilize applicable terminal screens including on-line documentation, intranet and internet navigation. 3. Initiate and code adjustment transactions to correct and resolve inquiries. 4. Analyze inquiries to anticipate and determine inquirer’s needs and next action to be taken to respond in a prompt and accurate manner. 5. Deliver agreed upon actions at stated time. 6. Collaborate with providers, families, and patients by ensuring communication is open and information appropriately shared (in compliance with HIPAA) to ensure member’s and provider’s needs are met. 7. Obtain required or missing information via correspondence or telephone. 8. Provide guidance to members when determining what products best suit their needs. 9. Assist members in assessing tools and decision-making around complex health issues, e.g. coordinate effective medical management. 10. Provide appropriate amount of information in a timely manner and confirm customer understands information. 11. Provide information and assistance to members with filing and pursuing a grievance or appeal. 12. Flexible in dealing with customer needs, including deviations of normal practices, procedures or benefit structures. 13. Recognize member as not only a customer but an individual whose health status/preferences are unique. 14. Recommend improvements in processing and procedures by informing appropriate personnel of revisions. 15. Adhere to production standards and goals. 16. Maintain liaison with various in-house areas regarding groups’ concerns, e.g. Marketing, Provider Affairs, and SSD. 17. Adhere to system generated schedule by Workforce Management to maximize customer service availability based on business needs. 18. Communicate and interact effectively and professionally with co-workers, management, customers, etc. 19. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. 20. Maintain complete confidentiality of company business. 21. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
  
  

JOB REQUIREMENTS: * High school diploma OR GED. * 6 months customer service experience OR 6 months experience in an office environment. * Data entry and/or typing experience. * Interpersonal, verbal and written communication skills. * Analytical and organizational skills and independent decision making skills. * Ability to spend approximately 90% of the scheduled time on the phone according to business needs and sit for long periods of time with scheduled breaks. PREFERRED JOB REQUIREMENTS: * 9 months customer service experience. * Experience working with various lines of business, i.e. CDHP, Medicare, Wellness, and Disease Management. * Knowledge of medical terminology and anatomy. * Proven ability to learn quickly and adapt to change. * Referral preference given to applicants able to take and meet testing criteria.

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HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.