Membership Service Advocate
- Cebu
- Permanent
- Full-time
- Update account information such as billing options and changes of address or phone numbers.
- Research premium billing discrepancies and prescription claims processed.
- Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of
- coverage.
- Submit mail requests for beneficiaries such as ID cards and formularies.
- Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if
- a drug is not covered, provide an explanation as to why.
- Displays positive demeanor, technical accuracy, and conformity to company policies.
- Understands CMS Guidance and ensures applicable Exhibits are being mailed per CMS Guidance.
- Ensure HIPAA regulations are maintained within the immediate environment.
- Responsible for concise and detailed notations as it pertains to member records.
- Handles outbound calls for purposes of validating information.
- Handles inbound calls by assisting members with a high level of accuracy and efficiency.
- Escalates any member issues to management as necessary.
- Responsible for maintaining a high level of call quality as set by client standards, which includes
- a 95% quality score, and answering 80-85% of calls within 30 sec. or less
- Communicate with coworkers, management, staff, customers, and others in a courteous and
- professional manner.
- Conform with and abide by all regulations, policies, work procedures and instructions.
- Respond promptly when returning telephone calls and replying to correspondence and faxes.
- Act, dress, and behave in a professional manner to reflect a positive image of the company.
- Meet average QA score of 95%
- Comply with attendance guidelines of 98%
- Schedule adherence of 90% or higher
- Maintain AHT below certain standards
- 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