Customer Service Ambassador

This is a fully remote position, open to applicants in Idaho, +3 more states.

📋 Description

• Act as the subject matter expert for the Partners in Care department.

• Provide support and coaching to Customer Service personnel.

• Manage and resolve escalated and intricate calls, claims, and inquiries from members, providers, employer groups, and healthcare professionals.

• Investigate and address claims, benefit administration errors, appeals, and correspondence issues in accordance with company policies and regulations.

• Clarify benefits, eligibility, claims procedures, pre-authorizations, and grievance/appeal processes.

• Mentor and assist Customer Service staff through individualized guidance, help line support, training, and onboarding.

• Collaborate with Medical, Legal, Provider Relations, Claims, and Pharmacy Services departments.

• Analyze data and trends to pinpoint recurring issues.

• Provide continuous education and suggestions to Customer Service leadership.

• Ensure that issue resolutions comply with corporate policies and regulatory standards.

• Serve as the authority on company policies, products, processes, and Coordination of Benefits.

⛳️ Requirements

• A high school diploma or GED is mandatory.

• At least 3 years of progressive member service experience is required.

• A combination of education and related technical work experience may be taken into account.

• Capability to report, analyze, and identify data trends to formulate action plans and evaluate results.

• Ability to accurately assess member inquiries and needs, establish rapport, identify errors, and implement corrective actions.

• Reliability, member and provider focus, and compliance with departmental performance standards.

• Experience with AI tools and technologies is highly preferred.

• Work-from-home setup must include a wired internet connection that is neither satellite nor cellular, with a minimum of 5 Mb upload and 10 Mb download speeds.

• Access to a personal mobile device for Multi-Factor Authentication setup is required.

• A successful background check is necessary.

🏝️ Benefits

• 5% bonus target.

• Medical, dental, and vision coverage for employees and eligible family members, which includes mental health benefits.

• Annual employer contribution to a health savings account.

• Generous paid time off that varies by role and tenure.

• 10 company-paid holidays.

• Market-leading retirement plan with company matching on employee 401(k) contributions.

• Potential discretionary retirement contributions based on company performance, with no vesting period.

• Up to 12 weeks of paid parental leave, subject to eligibility.

• Award-winning wellness programs that incentivize participation.

• Employee Assistance Fund.

• Commute and parking benefits.

• Flexible work-from-home options.

• Employee resource groups.

• Cambia-supported community outreach initiatives.

• Required wired internet connection and minimum internet speeds for remote work arrangements.

• Personal mobile device access for Multi-Factor Authentication.