Customer Care Advocate (Customer Care Representative)

Capital District Physicians Health Plan, Inc.; United States; On-site; USD 23,000 - 32,000; Full time

Benefits offered by this job

Remote work on case-by-case basis

Job summary

Capital District Physicians Health Plan, Inc. is seeking a Customer Care Advocate to resolve inquiries via phone, walk-in, mail, fax, web chat, and email regarding benefits, claims, enrollment, and related policies.

The role emphasizes patient and provider satisfaction while adhering to HIPAA and regulatory requirements.

Qualifications

• Level I: High School diploma or equivalent; entry level position; duties performed under close supervision.
• B Version: bilingual English/Spanish required (must speak Spanish fluently) and ability to multi-task in a fast-paced environment.
• Level II/III: progression with training and performance measures, mentoring responsibilities, and advanced problem-solving skills.

Responsibilities

• Resolve customer inquiries via multiple channels (phone, walk-in, mail, email, web chat).
• Provide professional, efficient, timely service to enhance member and provider satisfaction.
• Maintain privacy and follow HIPAA, privacy policies, and compliance guidelines.

Skills

Bilingual English/Spanish

Customer service

Communication

Problem solving

Education

High School diploma or equivalent

Tools

Windows

Job description

Job Description

Summary: The Customer Care Advocate (CCA) resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with LOS, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently.

Essential Responsibilities/Accountabilities

All Levels Provides service among the customers and business partners while responding in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention. Must exercise tact, patience, and professionalism at all times in responding to internal/external customers. Documents, researches, interprets and responds to inquiries from internal and external customers, business partners and special groups concerning our products, services and policies in accordance with LOS, NCQA, HIPAA, NYSDOH, CMS and other legislative requirements. Utilizes appropriate resources, resolves customer inquiries accurately & efficiently resulting in acceptable quality, first contact resolution/provider satisfaction, and performance. Provides outreach related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry. Demonstrates willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue identification and resolution. Participates in meetings, training, and skill development to support career path and individual development plans. Is knowledgeable and enthusiastic about the company and our products and/or services. Identifies and follows through on issues impacting the Health Plan and customer experience. Develops effective internal working relationships for improved communication and collaboration. Shares ideas and solutions to improve processes, procedures, and systems. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Regular reliable attendance is expected and required. Performs other functions as assigned by management.

Minimum Qualifications

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

Level I: High School diploma or equivalent, customer service experience preferred. Entry level position. Duties performed under close supervision.

B Version: Bi-lingual English/Spanish required (must have ability to speak Spanish fluently). Ability to multi-task to efficiently resolve customer concerns, by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously. Computer skills required, including the ability to navigate in a Windows environment. Skillful at working between multiple programs and applications at the same time. Organizational skills, reasoning, problem solving skills, effective and diplomatic communication, ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands. Successfully attends and completes all training as defined by the business unit.

Level Il - in addition to Level I requirements: Rating of “Performing” or above on the Agent Dashboard and Competencies for a minimum of 9 out of 12 months. Successfully complete training as required by the business unit. Ability to efficiently resolve complex & escalated issues with minimal direction. Advanced system and navigational skills. Expanded communication skills across multiple channels including, but not limited to, voicemail, email, web chat, outbound calls, membership growth, retention, etc. Takes accountability and ownership of issues and resolution with minimal supervision.

Level III - in addition to Level II requirements: Rating of “Performing” or above on the Agent Dashboard and Competencies for a minimum 10 out of 12 additional months. Successfully complete training as required by the business unit. Self-sufficient in resolving complex & escalated issues. Provide mentoring and support to new hires and peer group. Assist with tasks assigned by management that require advanced problem-solving skills. Demonstrates functional global thinking and takes initiative to recognize opportunities within the team.

Physical Requirements

Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time. The ability to hear, understand, and speak clearly while using a phone, with or without a headset. Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

Equal Opportunity Employer

Equal Opportunity Employer Please note: There may be opportunity for remote work within all jobs posted by the Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Compensation Range(s)

Grade N2: Minimum $20.00 Maximum $20.00 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package.

• Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Grade N2: Minimum $20.00 Maximum $20.00 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package.Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Company Culture

One Mission. One Vision. One I.D.E.A. One you. Together we can create a better I.D.E.A for our communities. At Excellus BCBS, we’re on a mission to make our communities healthier and we can't do it without you. We know diversity helps fuel our mission and that's why we approach our work from an I.D.E.A Mindset (Inclusion, Diversity, Equity & Access). By activating the experiences, skills, and perspectives of our employees, we take action toward greater health equity. We aspire to reflect the communities we live in and serve, and strongly encourage people of color, LGBTQ+ people, people with disabilities, veterans, and other underrepresented groups to apply.