Customer Service Advocate I
Group Health Incorporated (GHI) - Florida, NY

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This position is located in Hollywood, Florida.

Principal Accountabilities:
INITIATE and / or respond to telephone inquiries including contractual benefits, benefits eligibility, general requests (e.g. member ID cards and provider directories); HIP policies and procedures, HIPAA compliance issues, and assistance with selection and assignment of a Primary Care Physician.

FOLLOW UP effectively on inquiries through intervention and or investigation with other entities, including internal department, providers, etc., to obtain resolution.

PREPARE written responses (e.g., standard and custom letters) to member or provider inquiries when necessary.

CHECK e-mails daily and act accordingly (i.e. respond, if necessary and use to update reference materials, etc.).

KEEP reference and educational materials up-to-date.

DISPLAY outstanding attendance and punctuality.

PARTNER with the Manager, Customer Service, Quality Coaches and Quality Analysts on continuously improving quality and service ability.

UTILIZE AUX codes appropriately.

MASTER systems related to the job including Market Prominence and CSS/SAWS

FOLLOW all guidelines set forth in telephone scripts and monitoring forms.

REVIEW and WORK SAWS worklists daily to ensure they are current.

DEMONSTRATE sound judgment when deciding on the best course of action to take when working with members to ensure satisfaction while adhering to established policies and procedures.

Qualifications:

Education/Experience: The ideal candidate will possess a high school diploma and a minimum of one year of previous Customer Service experience. Successful completion of the Customer Service Advocate Training Program is required. Previous experience in the managed healthcare field is beneficial.

Skills/Knowledge/Competencies: The ideal candidate will possess the ability to absorb, retain, and effectively utilize a wide range of information regarding policies, procedures, benefits, etc. The qualified candidate must be able to communicate effectively and clearly while possessing excellent listening skills. The ability to perform basic arithmetic functions is required. Experience with Microsoft applications is required, along with the ability to type 25 wpm. Additional language skills are beneficial. The incumbent must have the ability to adhere to a work schedule which fluctuates according to the needs of the business while operating successfully in a rapidly changing environment.

Internal Posting Closing Date: 3/29/13

About this company
EmblemHealth is set on being the mark of good health in the Northeast. The not-for-profit company provides health...