Membership Service Advocate OTC (S2)
On-siteCebu, Cagayan Valley, Republic of the Philippines
Cebu, Cagayan Valley, Republic of the PhilippinesOn-siteFull TimeLarge
Full TimeLarge
Job Summary
Update account information, research premium billing discrepancies, and educate beneficiaries on plan benefits, cost sharing, and coverage levels. Submit mail requests for ID cards and formularies, verify drug coverage and tiers, and look up medicines on the formulary. Handle inbound and outbound calls with high accuracy, validate member information, and escalate issues to management as necessary. Maintain HIPAA regulations, ensure CMS guidance compliance, and document member records concisely. Meet a 95% QA score and 98% attendance guideline while adhering to all policies and procedures.
Required Qualifications
- Associate Degree preferably in Healthcare
- Minimum 3 years working in a fast paced high volume call center environment, retail customer service, preferably in healthcare or hospitality
- Ability to multi-task effectively with strong attention to detail when documenting customers reasons for calling
- Excellent written communication skills
- Excellent problem-solving abilities
- Must love customer service with excellent listening skills
- demonstrate empathy and the ability to educate customers
- Ability to de-escalate matters in a calm and professional manner
- Comfortable with technology and navigating numerous systems simultaneously
- Unwavering dedication to serving a customer that has complex needs
- Requires strong technical skills with Microsoft Office (Excel, word, and Outlook)
- Must have an energetic phone presence - professional etiquette over the phone, through written and face to face communication
- Self-motivated, confident, reliable and commitment to customer satisfaction
- Adherence to following internal policy
- Ability to interact professionally and maintain effective working relationships with superiors, coworkers, customers, and others
- Ability to break down complicated information into simple messages for the caller
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