Customer Advocate I

This is a fully remote position, open to applicants in United States.

📋 Description

• Accountable for addressing a range of inquiries from members and their dependents, hospitals, providers, attorneys, and agents.

• Interpret various contracts in response to inquiries regarding benefits and claims.

• Investigate membership databases and billing histories to resolve membership-related issues.

• Deliver exceptional customer service by handling phone calls, letters, and in-person inquiries.

• Educate and assist members with varying levels of health literacy, demonstrating cultural sensitivity.

• Record inquiries and associated correspondence in a computerized tracking system.

• Research relevant medical policies along with corporate, divisional, and departmental policies and procedures.

• Use information, claims data, and membership records to independently resolve issues or with minimal assistance.

• Take full responsibility for proactively maintaining knowledge bases (e.g., start-up notes, emails, Blue Help updates, etc.).

• Ensure confidentiality of all regulated information in accordance with state and federal regulations.

• Demonstrate professionalism by utilizing proper grammar and spelling in all verbal and written communication that is customer-focused, compliant, and tailored to the audience.

• Identify trends or recurring issues and communicate them to leadership as required.

• Offer solution options as needed.

• Apply effective time management techniques to prioritize competing projects and commitments to meet customer needs timely.

• Consistently deliver a positive experience for customers and members.

• For FEP positions, complete an additional FEP training program covering FEP systems and procedures.

⛳️ Requirements

• High school diploma or general education degree (GED) is required.

• A minimum of 2 years of experience in customer service, member services, or claims processing; or a combination of required education and experience.

• Advanced keyboarding skills are necessary.

• Intermediate proficiency in Microsoft Office is required.

• Previous experience handling provider calls, preferably with BlueCard, is essential.

• An associate's degree from a college or technical school is preferred.

• Experience with online customer service applications is preferred.

• Knowledge of medical terminology and ICD/CPT coding is preferred.

• Experience managing Blue KC member calls is preferred.

🏝️ Benefits

• Highly competitive total rewards package, which includes comprehensive medical, dental, and vision benefits, along with a 401(k) plan with contributions from both the employee and employer.

• Annual incentive bonus plan based on the achievement of company goals.

• Generous time away from work, including paid holidays, paid time off, and volunteer time off.

• Opportunities for professional development, mentorship, and a tuition reimbursement program.

• Paid parental leave and adoption leave, with financial assistance for adoption.

• Employee discount program.