Remote Sr. Customer Service Advocate

Essential Job Function:

• Responsible for outbound member calls to support various call campaigns:
  • Attribution – PCP confirmation or assist member to select PCP
  • Disruption – notify patient of health plan termination and assist with connecting to a broker
  • Appointment scheduling – assisting patient to schedule annual wellness visit
  • Medication adherence – discussing medication supply and connecting to health plan to enroll in mail order delivery
• Conducts 3-way call with patient and health plan for attribution call campaign.
• Handles member inbound calls to address inquiries for Medicare FFE members for providers enrolled in ACO reach. Completes detailed call documentation that is included in quarterly CMS reporting.
• Conducts outbound ‘secret shopper’ calls to confirm appointment availability at the practice locations.
• Conducts outbound calls to dialysis center to confirm required information has been submitted to CMS and captures the date of submission.
• Conducts outbound calls within CMS timeframe requirements to notify members of medication approval.
• Ability to clearly understand call campaign objective.
• Ability to access multiple systems and navigate while interacting with patients.
• Ability to shift between call campaigns without quality impacted.
• Ability to think critically when determining final call disposition.
• Completes accurate and detailed call documentation.
• Troubleshoots system/data issues to ensure the correct population is included in the call campaign.
• Escalates patient/member concerns appropriately to management.
• Maintains a calm demeanor whenever interacting with patients/members.
• Ability to adapt and think quickly to respond appropriately to member questions and/or concerns.
• Understands target success rate of each call campaign and drives performance to meet the expectation.
• Completes outbound calls timely and in accordance with the performance standards established within the customer service department.
• Facilitates communication through the Language Assistance Program (for members who are not English proficient) of the various plans, and/or arranges for interpreter, including interpretive services for the hearing impaired.
• Forwards calls as appropriate to supervisor or other staff for further response or follow up.
• Ensures confidentiality of all hard copy, electronic, and verbal communication, and adheres to organization’s policies related to privacy and disclosure.
• Promotes a positive image of the organization and the department in all aspects of communication and contact.
• Participates in regular training exercises to maintain program knowledge.
• Performs other duties as assigned.

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.
• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Engage in excellent communication which includes listening attentively and speaking professionally.
• Set and complete challenging goals.
• Demonstrate attention to detail and accuracy in work product.

Required Qualifications:

Minimum Experience

• Minimum of 12 months experience in Customer/Member services or related function in health care organization preferred.
• Experience with conducting member outbound calls.
• Experience in a managed care environment preferred.
• Demonstrated experience and expertise in customer service skills: excellent verbal and written communication skills, handling difficult communications with skill to achieve positive outcome, clear and concise targeted communications focused on the customer (verbiage, language, style, etc. all may vary depending on the customer/audience).
• Bilingual (English/Spanish) preferred

Education/Licensure:

• Minimum educational level, high school diploma. Some college level course work preferred.