Member Services Advocate

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

📋 Description

• Acts as an advocate for members, serving as a primary contact for inquiries and concerns related to benefits, eligibility, referrals, claims, and other aspects of plan services.

• Ensures member satisfaction by delivering exceptional customer service and maintaining a professional demeanor at all times.

• Delivers quality customer service by implementing the SCAN Five Service Principles.

• Provides education to members, families, providers, and caregivers about benefits and plan options.

• Clearly articulates benefits and plan options through in-person meetings, emails, or phone calls.

• Follows up with members to clarify issues, identify causes, and explain solutions effectively.

• Escalates relevant member issues to management or other departments as necessary.

• Consistently meets or surpasses departmental standards, including quality, productivity, and adherence to scheduling and attendance.

• Responds promptly and appropriately to inquiries from members, internal staff, and providers regarding benefits, eligibility, referrals, claims, and other issues while following departmental policies and procedures.

• Takes ownership of issues, concentrating on providing solutions and options until member concerns are resolved.

• Enhances member satisfaction by efficiently addressing and resolving issues, complaints, and questions, coordinating with providers and other departments as required.

• Participates in member call projects assigned by management to support SCAN's overall membership retention goals.

• Adheres to policies and procedures, suggesting improvements and efficiencies to management; identifies and reports workflow issues according to departmental protocols; actively engages in departmental meetings and training sessions.

• Complies with all relevant Federal and State regulations applicable to Scan Health Plan operations, as detailed in company policies and procedures.

• Maintains compliance with HIPAA requirements.

• Documents transactions by completing necessary member forms and summarizing actions taken in the appropriate computer systems, adhering to departmental standards.

• Temporarily manages routine member inquiries on specific medical group call queues for skill development.

• Contributes to team success by achieving related results as necessary.

⛳️ Requirements

• 1-2 years of experience in a call center or related customer service role is required.

• 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans, is preferred.

• Experience within the healthcare, insurance, or pharmacy sectors is highly desirable.

• Ability to maintain a calm demeanor at all times, even in high-pressure situations.

• Proficient in data entry and general computer skills (including word processing and email) is required.

• Strong communication skills, both oral and written.

• Professional and pleasant telephone manner is essential.

• Capability to handle a high volume of calls while consistently delivering excellent customer service is required.

• Proven efficiency and effectiveness in a high-call-volume environment.

🏝️ Benefits

• An annual employee bonus program.

• Comprehensive Wellness Program.

• Generous paid time off (PTO) including 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days.

• Excellent 401(k) Retirement Savings Plan with employer matching.

• Strong employee recognition program.

• Tuition reimbursement.