Member Services Advocate

Convey Health Solutions; United States; Remote; USD 38,000 - 52,000; Full time

Job summary

Convey Health Solutions is seeking a Member Services Advocate to support beneficiaries with account updates, plan information, and issue resolution, delivering an outstanding customer care experience.

You will handle inbound/outbound calls, educate on benefits, verify formulary coverage, process mail requests, and maintain HIPAA compliance with a focus on accuracy, courteous service and meeting QA goals.

Qualifications

• Highschool Diploma is required.
• Minimum 2 years in a fast-paced high-volume call center, retail CS or hospitality; healthcare experience a plus.

Responsibilities

• Update account information such as billing options and address/phone changes.
• Research premium billing discrepancies and prescription claims processed.
• Educate beneficiaries on plan benefits, cost sharing and coverage levels.
• Submit mail requests for ID cards and formularies.
• Look up formulary coverage, tier and copay; explain when not covered.
• Maintain positive demeanor, accuracy and adherence to policies.
• Understand CMS Guidance and ensure Exhibits mailed per CMS guidance.
• Maintain HIPAA regulations within the environment.
• Keep concise, detailed notes for member records.
• Handle outbound calls to validate information.
• Handle inbound calls with high accuracy and efficiency.
• Escalate member issues to management as needed.
• Maintain 95% QA score and 80–85% calls answered within 30 sec.
• Communicate with coworkers, management and customers professionally.
• Follow all regulations, policies and procedures.
• Respond promptly to calls and correspondence.
• Present a professional image reflecting the company.

Skills

Customer service

Attention to detail

Organized

Communication skills

HIPAA compliance

CMS guidance knowledge

Call center experience

Education

Highschool Diploma

Job description

Remote

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
• Minimum 2 years working in a fast-paced high volume call center environment, retail customer service or hospitality. Healthcare experience is a plus.