Member Services Advocate

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

About Us
Convey Health Solutions, together with Pareto Intelligence™, delivers a powerful combination of purpose-built technology, advanced analytics, and expert services to help health plans thrive in a complex, post--Affordable Care Act environment.
As a trusted partner to Medicare and commercial payers, we provide scalable, compliant solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment, Stars performance, and member engagement. Pareto's deep analytics and financial intelligence complement Convey's operational expertise, enabling our clients to improve performance, reduce costs, and create better healthcare experiences for millions of Americans--especially seniors and vulnerable populations.
Together, we help health plans scale smarter, grow stronger, and make healthcare work better for the people who need it most. Learn more at http://www.ConveyHealthSolutions.com

Job Description

Job Title: Member Services Advocate

Position Summary:

We at Convey Health Solutions focus on building specific technologies and services that can uniquely meet the needs of government-sponsored health plans. We provide member management solutions for the rapidly changing healthcare world. We are looking for people to help be a part of those solutions.

As a Member Services Advocate, you will be a part of a team that transforms customer service into customer care by delivering an amazing experience. You will assist beneficiaries with a wide range of critical services which include but not limited to updating account information, providing plan information and resolving issues with utilization of the plan. Qualified candidates will have a strong desire to help people, strong customer care skills, attention to detail and be very organized.

Essential Duties and Responsibilities:

As our customers share concerns and provide us with valuable feedback, your ability to recognize and complete the steps necessary to meet their needs will leave a permanent, lasting impression of the passion you have for helping them be at their best.

We make sure our customers are not alone when it comes to understanding their benefits and they will rely on you to advocate for them as you would your own family member.

In addition to the keys to success identified above that you will bring with you to the team, you will need to demonstrate the following abilities:

• 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.

MONTHLY GOALS:

• Meet average QA score of 95%
• Comply with attendance guidelines of 98%
• Schedule adherence of 90% or higher
• Maintain AHT below certain standards

Education and Experience:

• 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.

Company

Convey -- US

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Convey Health Solutions

Employer Privacy Policy

Equal Employment Opportunity Statement:

Convey Health Solutions is an Equal Opportunity Employer committed to fostering an inclusive and diverse workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.

Convey Health Solutions also provides reasonable accommodations to qualified individuals with disabilities in accordance with applicable laws. Applicants requiring accommodation during the application or interview process should contact the Human Resources department.

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