Customer Care Advocate IA - DeWitt

Excellus Health Plan Inc. in; Town of De Witt (NY); Presencial; USD 20.000 - 27.000; Jornada completa

Descripción de la vacante

Excellus Health Plan Inc. is seeking a Customer Care Advocate IA in DeWitt, NY. The role handles inquiries via telephone, mail, email, and web channels, supporting member and provider needs with professionalism and efficiency.

The position emphasizes privacy compliance and strong customer service, with shift-level responsibilities and ongoing training to develop skills in claims, enrollment, and provider inquiries.

Formación

• High School diploma or equivalent required.
• Customer service experience preferred.
• Bi-lingual English/Spanish required (must have ability to speak Spanish fluently).
• Ability to multi-task and navigate multiple programs.

Responsabilidades

• Respond to inquiries to enhance member and provider satisfaction.
• Document, research, and respond to inquiries per policies and regulations.
• Resolve customer inquiries with First Contact Resolution and quality.
• Assist with claims, onboarding, and provider inquiries.

Conocimientos

Customer service

Multitasking

Communication

Windows navigation

Educación

High School diploma or equivalent

Herramientas

Windows OS

Descripción del empleo

Customer Care Advocate IA - DeWitt (Finance)

Thank you for your interest in our Customer Care team. Due to the volume of applications we receive, we review all applications in the order in which they were received. If you are chosen to move to the next step in the process, you will receive a Video Assessment from [e-mail].

Summary

The Customer Care (CC) Advocate 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 MTM, 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

• 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 MTM, NCQA, HIPAA, NYSDOH, CMS and other legislative requirements.
• By utilizing appropriate resources, resolves customer inquiries accurately & efficiently resulting in acceptable quality, First Contact Resolution, 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.
• Ongoing participation 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 required.
• Customer service experience preferred.
• Entry level position. Dutes performed under close supervision.
• Attends all training required to become proficient in position.
• B Version: Bi-lingual English/Spanish required (must have ability to speak Spanish fluently).
• Ability to multi-task in order 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.
• Excellent computer skills required, including the ability to navigate in a Windows environment. Skillful at working between multiple programs and applications at the same time.
• Adept at communicating effectively and diplomatically while working as a collaborative team member.
• Organizational, reasoning and problem-solving skills.
• Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands.
• Completed training on at least one part of Scheduling 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.
• Completed training on all parts of scheduling 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.
• Dental & Medical Intake Units Specific:
  • Rating of "Performing" or above on the Agent Dashboard and Competencies for a minimum of 9 out of 12 months.
  • -OR- Move to & complete training for Commercial Unit.

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.
• 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 global thinking and takes initiative to recognize opportunities within the team.
• Dental & Medical Intake Units Specific:
  • There is no level III option for these two units. Must move to Commercial unit to continue level progression.

• Commercial Unit Specific:
  • Rating of "Performing" or above on the Agent Dashboard and Competencies for a minimum of 10 out of 12 months.
  • -OR- Move to & complete training for Dedicated Unit.

Physical Requirements

• Work is completed in a traditional office environment under fluorescent lighting.
• Ability to arrive on time at work and as scheduled.
• Ability to meet minimum performance metrics.
• Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time.
• Must be able to travel across the enterprise.
• Regularly required to talk.
• Regularly required to hear.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade N2: Minimum $18.22 - Maximum $23.89

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.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus 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.