Service Advocate - Remote

The hours of this role will fall between 8am-9pmEST Mon-Fri.

POSITION SUMMARY

Highly technical Customer Service expert with depth of knowledge within a health care setting.

This position will require highly analytical, advanced ability to connect with the member, with a depth of knowledge in resolving and navigating within a health care setting.

This position supports medical health plan clients with benefit needs and will also have the expanded responsibility of recommending vendor programs and services.

Although this position is within a call center, it differs from typical call center roles due to the requirement and ability to independently seek solutions to customer needs.

Candidates must have a proven track record in resolving claims issues, navigating complex health conditions and be the embodiment of empathy as their key driver in member experience.

Possesses relationship building behaviors including, but not limited to: empathy, curiosity and helpfulness.

Ability to demonstrate active listening, critical thinking, building rapport and being proactive.

Clearly demonstrates application of resources and support to provide solutions to customer.

Ideal candidates must have the ability to listen intently to what is being shared by the customer to recommend medical benefit and vendor offerings that will achieve optimal emotional, financial and physical health outcomes.

Takes ownership for customer's inquiry and follows through to completion, removing the customer "from the middle".

This position must think and perform more critically, leveraging their call center experience, creative thinking, and keen problem solving skills to take their service in this role to the next level.

The ability to operate in the absence of precise work instructions is critical for success.

This position will have the following multifaceted responsibilities:


* Responsible for providing high level of service to inbound calls, outbound calls, direct messaging and digital chat customers with more complex medical conditions and/or needs.


* Will educate customer on Medical health plan benefit package and vendors to enable optimal health outcomes.


* Conducts in-network provider searches and facilitates appointment scheduling.


* Provides advanced support with prior authorizations, helping to navigate next steps on denials and/or missing information.


* Investigates and resolves escalations, issues, complaints obtaining necessary information from policies, procedures, or practices.

When knowledge articles are not available to guide next steps, must be able to autonomously and accurately determine the best solution or option for customer.


* Highly organized with ability to follow-up timely and communicate proactively to customer and other necessary parties.


* May serve as primary contact and liaison between customers, health plans, service centers, and/or functional areas.


* Must have thorough technical knowledge of assigned produc...