Customer Service Advocate II (Remote)

CareFirst BlueCross BlueShield is a health insurance company, and they are seeking a Customer Service Advocate II to handle member inquiries regarding product information, benefits, and claims in a call center environment. The role involves providing technical assistance and educating members about various health and financial programs.

Responsibilities:

• Provides first- level problem resolution to member, provider inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures
• Uses knowledge of products or services by collecting and the contractual provisions that govern administration to provide customer information service and analyzing education, to interpret contractual language to the customer needs for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. Appropriately documents all client interactions according to established departmental procedures
• Prioritize workflow & multitask efficiently in a fast pace environment while using multiple skill sets with demonstrated proficiency
• Delivers accurate information to customers in accordance with performance goals and objectives
• Maintains customer advocate records by identifying underlying customer needs and guiding them to appropriate resources or programs updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes
• Participates in system testing as needed and ongoing education related to new services, industry topics, and skills

Requirements:

• High School Diploma or GED
• 3 years customer service experience
• Demonstrated skills as an empathetic and compassionate communicator
• Ability to quickly gain customer trust and confidence
• Demonstrated PC navigation and data entry skills
• Strong interpersonal communication skills
• Good oral and written communication skills
• 3 years experience in a call center customer service role or experience with medical or insurance terminology