Advanta Advocate-Customer Care Agent

MedImpact Healthcare Systems; Tempe (AZ); Sur place; USD 27 000 - 43 000; Plein temps

Résumé du poste

Verdegard in Tempe, AZ seeks an Advanta Advocate to assist enrolled employees with health insurance plans, negotiating with facilities and providers to secure the best care at the best price. You will interact with internal and external customers to deliver outstanding service and ensure quality, under general supervision.

The role requires a GED/HS Diploma and 2+ years of related experience, with strong MS Office skills and the ability to follow procedures across multiple teams.

Qualifications

• GED/HS Diploma required; 2+ years of related experience.
• Strong communication and customer-service skills.
• Ability to follow procedures and work under supervision.

Responsabilités

• Coordinate and communicate pre- and post-service cases between teams.
• Respond to member inquiries and resolve issues promptly.
• Negotiate with providers to deliver quality and cost-effective care.
• Research and resolve complex benefit questions using company databases.
• Educate members about plan details, authorizations, and appeals.
• Follow up to ensure satisfaction and timely responses.
• Represent Verdegard professionally and adhere to policies.
• Other duties as assigned.

Connaissances

Composure

Decision Quality

Organizational Agility

Problem Solving

Customer Focus

Drive for Results

Peer Relations

Time Management

Dealing with Ambiguity

Learning on the Fly

Politics

Formation

GED/HS Diploma

2+ years experience

Outils

MS Office/Word/Excel/Outlook

Windows-based databases

Description du poste

Exemption Status: United States of America (Non-Exempt)

Exemption Status: $19.80 - $25.50 - $31.19

"Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate."

Verdegard is looking for extraordinary people to join our team!

Why join Verdegard?

Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

Job Description

Summary

Works as a member of the Advanta Advocate team working directly with enrolled employees (members) on their medical health insurance plan. The Advocates negotiate with facilities and providers working towards obtaining the best care at the best price for their health needs. Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform the functions of the job.

Essential Duties and Responsibilities

• Advocates coordinate and communicate Pre and Post Service cases between operation, account management, sales, health services, stop loss, finance, clients, brokers, facilities and members.
• Convey a positive image of the company by promptly responding to member phone inquiries and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance.
• Deliver service that meets or exceeds department performance standards when negotiating with facilities, providers and the delivery of options to members.
• Utilize company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other TPA processes. Request follow-up action or obtain assistance from other areas of the organization as necessary.
• Educate external customers/members about Verdegard's roles and responsibilities. Provide information about override guidelines, benefit plans, prior authorization requirements, grievance and appeal processes, and other TPA functions as specified by health plan sponsors in accordance to their health plan.
• Follow up with customers/members as appropriate to ensure satisfaction and timely response to requests. Diffuse upset customers/members by appropriately listening to issues and providing positive solutions to resolve concerns.
• Represent Verdegard in a positive manner by adhering to processes and established procedures and guidelines. Support the department strategy by working with the customer/member to have the best experience with their health plan and help find financial savings through negotiations with their providers and facilities and redirecting to more cost-effective provider locations.
• Other duties may be assigned.

Supervisory Responsibilities

No supervisory responsibilities

Education and/or Experience

GED/HS Diploma and 2+ years' experience or equivalent combination of education and experience

Computer Skills

Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs. Experience with Windows based database programs is also required.

Certificates, Licenses, Registrations

None required

Other Skills and Abilities

Demonstrates ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Mathematical Skills

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.

Language Skills

Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Competencies To perform the job successfully, an individual should demonstrate the following competencies:

• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Polit