Remote Member Care 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

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.