Member Care Advocate for Medicare Plans

HealthSmart International; Fort Lauderdale (FL); Hybrid; USD 32,000 - 52,000; Full time

Job summary

Convey Health Solutions is seeking a Member Services Advocate to assist beneficiaries with account updates, plan information and issue resolution, delivering an excellent member experience.

You will advocate for members, educate on benefits and help with billing questions while maintaining privacy standards and high-quality service. A high school diploma and 2+ years in a fast-paced call center or similar setting are expected.

Qualifications

• Highschool Diploma is required and an Associate Degree preferable.
• Minimum 2 years working in a fast-paced high volume call center environment, retail customer service or hospitality. Healthcare experience is a plus.
• Qualified candidates will have a strong desire to help people, strong customer care skills, attention to detail and be very organized.

Responsibilities

• Update account information such as billing options and changes of address or phone numbers.
• Research premium billing discrepancies and prescription claims processed.
• Educate beneficiaries on how the plan works, including benefits, cost sharing and levels of coverage.
• Submit mail requests for beneficiaries such as ID cards and formularies.
• Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why.
• Displays positive demeanor, technical accuracy and conformity to company policies.
• Understands CMS Guidance and ensures applicable exhibits are being mailed per CMS Guidance.
• Ensure HIPAA regulations are maintained within the immediate environment.
• Responsible for concise and detailed notations as it pertains to member records.
• Handles outbound calls for purposes of validating information.
• Handles inbound calls by assisting members with a high level of accuracy and efficiency.
• Escalates any member issues to management as necessary.
• Responsible for maintaining a high level of call quality as set by client standards, which includes a 95% quality score and answering 80-85% of calls within 30 sec or less.
• Communicate with coworkers, management and customers in a courteous/professional manner.
• Conform with and abide by all regulations, policies, work procedures and instructions.
• Respond promptly when returning telephone calls and replying to correspondence.
• Act and behave in a professional manner to reflect a positive image of the company.

Skills

Call center experience

Customer care

Attention to detail

Organized

Empathy

Education

Highschool Diploma

Associate Degree

Job description

Convey Health Solutions is seeking a Member Services Advocate to assist beneficiaries with account updates, plan information and issue resolution, delivering an excellent member experience.

You will advocate for members, educate on benefits and help with billing questions while maintaining privacy standards and high-quality service. A high school diploma and 2+ years in a fast-paced call center or similar setting are expected.