The Customer Satisfaction Advocate resolves customer and prospective customer inquiries via telephone, walk in, mail, fax, web chat and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA and legislative requirements, standards set forth by the Safety Net and Government Programs division and New York State Department of Health. Incumbents exercise tact, patience, and professionalism at all times in responding to internal/external customers, regardless of the issue or the customer’s demeanor and demonstrates flexibility with scheduling to meet customer demands. Acts as a liaison among the customers, business partners, and plans in a professional, self-directed manner to ensure and promote customer satisfaction and retention.
• Researches, interprets and responds to inquiries from internal and external customers, business partners and special groups concerning our products, services and policies in accordance with MTM, NCQA, HIPAA, NYSDOH and other legislative requirements.
• Resolves customer inquiries in an accurate, organized, efficient, and expert manner; resulting in acceptable accuracy and production levels and retention of subscriber contracts.
• Develops skills necessary to continuously improve upon issue resolution as defined under tier 1 training.
• Responds to internal and external customers in a professional, efficient manner to encourage public acceptance of corporate products, services, and policies.
• Identifies patterns generated by external and internal action effecting customer satisfaction.
• Identifies and follows through on potential issues affecting the insurance industry including, but not limited to competitive plans, health care financing and delivery systems, NYSDOH requirements, trends and concepts that impact managed health care.
• Participates in the training needed to learn regulations, legacy systems, procedures, develop skills and initiate actions to accurately fulfill all requirements of the job.
• Consistently adheres to all Customer Service policies, procedures, and performance measures including inquiry documentation procedures.
• Maintains accurate and up-to-date knowledge of all Safety Net and Government Programs products and regulations and communicates to prospective and current members in a clear and concise manner to ensure understanding of the products through intervention and education in obtaining health care services appropriately via phone, letter, and/or face to face - including, scheduling appointment for Facilitated Enrollers.
• Receives and responds to customer voice mails, internet messages, mail, faxes, scans; sorts and records in appropriate system and works appropriately. Tracks incoming inventory and tasks that are completed offline.
• Reviews, validates and keys Medicaid Managed Care enrollment forms into the appropriate system.
• Assists current members with daily inquiries, such as, completing new applications and recertification, benefit, contract, eligibility and claim inquiries in a professional manner in accordance with Corporate, Safety Net and NYSDOH guidelines and documents all member contacts utilizing the appropriate tracking system.
• Assists prospective members with completing new applications. Reviews all necessary documentation required and provides step-by-step instruction to complete the application in a professional and timely manner in accordance with Corporate, Safety Net and NYSDOH guidelines and document all prospective member contacts utilizing the appropriate tracking system
• Works on a variety of membership related reports for Univera Community Health and Health Plan.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required
• Performs additional duties as assigned by Management.
• Entry level position
• Duties performed under close supervision
• Attends all training required to become proficient in position
• Successful completion and proven proficiency of skills as defined under tier 2 training.
• Duties performed under limited supervision
• Resolves customer inquires across multiple lines of business
• Staff rotation on Assist Queue
• Initiates involvement for higher level responsibilities or proactively volunteers for assisting in the resolution of escalated or systemic issues.
• Associates degree in Business Administration, Health Care Administration, Health Economics or related or 1 year of customer service experience required; preferably in a call center environment.
• Ability to multi-task in order to efficiently resolve customer concerns, by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously.
• Excellent computer skills required, including the ability to navigate in a Windows environment. Skillful at working between multiple programs and applications at the same time.
• Adept at communicating effectively and diplomatically.
• Organizational, reasoning and problem solving skills.
• Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands.
• Ability to work effectively as a member of a team.
In addition to Level I qualifications:
• Minimum of 12 months experience in a Level I CSA position
• No performance management issues in the last six months
• Proficiency at Level I as demonstrated by last three months of performance
• No more than one finding in all quality benchmark touchpoint measures.
• Rated Performing or above at Level I
In addition to Level II qualifications:
• Minimum of 12 months experience in a Level II CSA position
• No performance management issues in the last six months
• Proficiency at Level II as demonstrated by last three months of performance
• No findings in any quality benchmark touchpoint measures.
• Rated High Performing or above at Level II
• Work is completed in a normal office environment under fluorescent lighting.
• Ability to use a headset to listen to customer conversations required.
• Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer