Customer Care Advocate IA - Rochester

Excellus Health Plan Inc.; City of Rochester (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Customer Care Advocate to join their team. This role involves resolving customer inquiries through various channels, ensuring high satisfaction and retention. The ideal candidate will be bilingual in English and Spanish, possess strong problem-solving skills, and thrive in a fast-paced environment. This position offers a chance to grow within a supportive and inclusive company culture that values diversity and innovation. If you are passionate about customer service and ready to make a difference, this opportunity is for you!

Benefits

Health Insurance

Retirement Plans

Paid Time Off

Wellness Programs

Holidays

Qualifications

• Customer service experience preferred.
• Ability to multitask effectively while maintaining professionalism.

Responsibilities

• Provide service to customers, enhancing satisfaction and retention.
• Document and respond to inquiries from customers and partners.

Skills

Customer Service

Bilingual (English/Spanish)

Problem-Solving

Organizational Skills

Communication Skills

Education

High School Diploma or Equivalent

Tools

Windows Environment

Multiple Applications

Job description

Job Description:

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 professionally, efficiently, and promptly to resolve issues and improve member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently.

Essential Responsibilities/Accountabilities

All Levels

1. Provide service to customers and business partners, responding professionally and efficiently to enhance satisfaction and retention. Exercise tact, patience, and professionalism at all times.
2. Document, research, interpret, and respond to inquiries from internal and external customers, business partners, and special groups regarding products, services, and policies, complying with MTM, NCQA, HIPAA, NYSDOH, CMS, and other legislative requirements.
3. Utilize appropriate resources to resolve customer inquiries accurately and efficiently, aiming for high quality, First Contact Resolution, and performance.
4. Conduct outreach related to claims, onboarding, effectuation, retention, provider inquiries, and other complex issues.
5. Show willingness to adapt to changes and business needs, taking ownership for issue identification and resolution.
6. Participate in meetings, training, and skill development to support career growth and individual development plans.
7. Be knowledgeable and enthusiastic about the company and its products/services.
8. Identify and follow up on issues affecting the Health Plan and customer experience.
9. Develop effective internal relationships for better communication and collaboration.
10. Share ideas and solutions to improve processes, procedures, and systems.
11. Maintain high standards of integrity, supporting the company's mission, values, and Code of Conduct.
12. Protect member privacy according to corporate policies and procedures.
13. Maintain reliable attendance.
14. Perform other functions as assigned by management.

Minimum Qualifications

Note: We include multiple levels of classification based on knowledge, skills, and ability to handle increasingly complex tasks, broader responsibilities, and decision-making. This approach guides employee development and promotional opportunities.

Level I:

• High School diploma or equivalent required.
• Customer service experience preferred.
• Entry-level position, duties performed under close supervision.
• Complete all required training.
• B Version: Bilingual English/Spanish required (must speak Spanish fluently).
• Ability to multitask effectively, including active listening, navigating screens, typing, and speaking simultaneously.
• Excellent computer skills, including navigating in a Windows environment and working across multiple applications.
• Effective and diplomatic communication skills, collaborative team work.
• Strong organizational, reasoning, and problem-solving skills.
• Ability to prioritize, multitask, and remain professional under pressure.
• Complete training on at least one part of Scheduling unit.

Level II:

• Rating of "Performing" or above on the Agent Dashboard and Competencies for at least 9 out of 12 months.
• Complete training on all parts of scheduling unit.
• Resolve complex and escalated issues efficiently with minimal guidance.
• Advanced system and navigational skills.
• Expanded communication skills across multiple channels.
• Take accountability and ownership of issues and resolutions with minimal supervision.
• Specific to Dental & Medical Intake Units: same performance rating requirement or move to & complete training for Commercial Unit.

Level III:

• Rating of "Performing" or above for at least 10 out of 12 months.
• Self-sufficient in resolving complex and escalated issues.
• Mentor and support new hires and peers.
• Assist with tasks requiring advanced problem-solving skills.
• Demonstrate global thinking and initiative.
• For Dental & Medical Intake Units: no Level III option; move to Commercial unit for progression.
• For Commercial Unit: same performance rating requirement or move to & complete training for Dedicated Unit.

Physical Requirements

• Work in a traditional office environment with fluorescent lighting.
• Arrive on time and meet performance metrics.
• Ability to sit at a desk and use a computer for 3+ hours.
• Travel across the enterprise as needed.
• Regularly talk and hear.

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The Lifetime Healthcare Companies aim to attract diverse talent to reflect the communities we serve, fostering an inclusive environment where diversity and inclusion are core values. We believe diverse perspectives drive innovation and excellence in healthcare insurance and services. We recruit from all backgrounds to strengthen our workforce.

Company Culture:

Employees are united by our Lifetime Way Values & Behaviors: compassion, pride, excellence, innovation, and having fun! We value diversity, innovative thinking, employee development, and offer competitive benefits.

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

Equal Opportunity Employer

Compensation Range(s):

Grade N2: Minimum $18.22 - Maximum $23.89

The salary range is indicative; actual salary varies based on experience, knowledge, skills, education, and internal equity. Compensation includes total rewards such as health insurance, retirement, wellness programs, paid time off, and holidays.

Remote work opportunities may be available and are decided case-by-case.

All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.