For this opening we will consider candidates from the following locations: PLYMOUTH MEETING,PA,US |
Our Customer Care Associates are compassionate and dedicated professionals with exceptional listening skills who assist our members in navigating the healthcare system. They work as part of a team and demonstrate customer service excellence.
Essential Job Functions:
- Receives member's pre-service requests on the toll free 800#, determines needs, gets demographic information and directs to proper area of responsibility, if it is symptom related or post-service request.
- If the caller is requesting routine locator information, the Customer Care Associate can help them directly (e.g. eldercare assistance, health and Rx plan schedules, identifying resources for employer health plans).
- Achieve or exceed Call Center Metrics.
- Assist members and their families with basic healthcare questions and helps them to understand and utilize their health insurance benefits coverage.This request can come from the member or from another member of the Health Advocate staff
- Handle routine to moderate issues with regular supervision such as answering member questions, dealing with irate members and assisting other departments with their member cases.
- Regular contact with members, physician office receptionist and insurance carrier customer service representatives.
- Achieve/exceed call center metrics (ASA=<30 seconds; Abandon Rate = <5%)
- Identify target resolution for all member calls and then, if possible, ensure cases close at or near the target resolution
- Inform members of your plan of action, expected results and timeframes, then meet or exceed those timeframes
- Build confidence in our services to encourage members to call back with future questions
- Allay member anxiety and frustration
- Add value to our services by going beyond the member's initial request
- Locate providers for routine care (non-symptom based) using HA's policy and procedure
- Assist PHA's in the location of healthcare providers
- Research of employer group plan documentation, and the communication with insurance carrier representatives
- Clarify insurance plan provisions to members
- Link members to the appropriate health care services and providers; locate participating providers
- Assist seniors and their families in finding senior housing and care facilities, health and prescription plans
- Document all cases in case management system using the SOAP method (Subjective, Objective, Assessment, Plan) when appropriate
- Research, locate services as requested by members including gym and exercise classes, smoking cessation programs
- Intercedes for the member to obtain earlier appointments
- College degree or one to three years customer service experience, preferably in healthcar
- Understanding of basic medical terminology to assist in locating appropriate care option
- Telephone triage experience helpful
- Understanding of health benefit plans and the insurance industry
- Understanding of medical procedures, including billing, diagnosis codes and pre-certification
- Understanding of Home Care Services
- Strong desire to provide outstanding customer service
- Ability to work as part of a team
- Ability to educate callers
- Strong listening skills and empathy
- Ability to ask open-ended questions and uncover information
- Effective communication skills to interact with members, physicians, and insurance carrier representatives
- Ability to calm anxious callers and defusing angry or hostile callers
- Assertive, self-confident and resilient
- Attention to detail and strong documentation skills
- Demonstrate appropriate judgment in escalating cases in a timely manner to supervisors
- Ability to think outside the box
- Well organized, meticulous attention to detail with ability to multi-task
- Proficient computer skills (Microsoft Office, Excel, Outlook, Adobe PDF, Internet Searches)
Hours of operation are:
- Monday - Friday
- Full Time: 1 - 9:30 pm; 1:30 - 10 pm
- Part time hours will be considered between 1:00-10:00 pm
Hourly compensation includes 10% shift differential, if applicable.