Customer Experience Associate- HMSA (Remote, must reside in Hawaii)

Magellan Health; Ewa Beach (HI); Remote; USD 35,000 - 50,000; Full time

Job summary

A leading healthcare company is seeking a Customer Experience Associate to support members and providers in Hawaii. This role involves handling calls related to healthcare benefits, ensuring outstanding service, and meeting performance metrics. The ideal candidate will have customer service experience and the ability to navigate multiple applications efficiently.

Qualifications

• Minimum 1-2 years of customer service experience.
• Proficiency with keyboard functions and navigating multiple applications.
• Flexibility in scheduling and adaptability to change.

Responsibilities

• Research and communicate medical information regarding services.
• Meet key performance indicators and service standards.
• Facilitate routine referrals and triage decisions.

Skills

Customer Service

Communication

Attention to Detail

Flexibility

Education

GED

High School Diploma

Associate Degree

Bachelor's Degree

Job description

Customer advocate role supporting our members and providers, facilitating care and service. This is a service position providing assistance to Magellan's members, providers, and clients regarding various aspects of our programs, policies, and procedures. Responsibilities include handling incoming/outgoing calls related to healthcare benefits and administering intake documentation into the appropriate systems. The role requires delivering outstanding service to internal and external customers and resolving callers’ needs on the first call. Performance expectations include meeting or exceeding customer expectations and quality standards.

Responsibilities

1. Research and clearly communicate medical information regarding services such as claims, member eligibility, benefits, EAP services, claim status, and authorization inquiries, while maintaining confidentiality and Protected Health Information (PHI).
2. Meet key performance indicators and service standards with compassion, aligning with Magellan’s values and mission.
3. Identify and respond to crisis calls with appropriate resources.
4. Facilitate routine referrals and triage decisions that do not require clinical judgment.
5. Accurately assemble and enter patient information into the appropriate systems.
6. Demonstrate flexibility in job duties and schedules to better serve members and support organizational goals.
7. Support team members and participate in activities to foster a high-performance team environment.
8. Engage in ongoing self-development and career progression through training and education.
9. Stay informed of operational changes and update knowledge to ensure accuracy.
10. Identify operational problems or inefficiencies and bring them to the attention of responsible entities.
11. Lead or participate in activities aimed at improving performance, quality, and culture within the Care Center.
12. Navigate Magellan’s systems, document customer comments and information, and forward necessary details.
13. Ensure accurate and appropriate call handling based on disseminated information.

Other Job Requirements

• Minimum 1-2 years of customer service experience.
• Ability to talk and type simultaneously with attention to detail.
• Flexibility in scheduling and adaptability to change.
• Meet monthly call center performance metrics.
• Consent to recording and evaluations for training and compliance purposes.
• Proficiency with keyboard functions and navigating multiple applications.

General Job Information

• Title: Customer Experience Associate- HMSA (Remote, must reside in Hawaii)
• Grade: 17
• Work Experience - Required: Customer Service
• Work Experience - Preferred: Call Center, Healthcare
• Education - Required: GED, High School
• Education - Preferred: Associate, Bachelor's
• License and Certifications - Required: None specified
• License and Certifications - Preferred: None specified