JOB SUMMARY:

The Customer Service Advocate III is a position within the Community Health Choice Provider Call Center. The Customer Service Advocate III is primarily responsible for, but not limited to responding to incoming provider hotline inquiries as they relate to benefit and eligibility verification, claim status (with the ability to identify if a claim requires reconsideration), authorization status, and complaints, accurate documentation recording of all provider calls; effective follow-up of provider calls, as required; and proper electronic routing with effective documentation skills.

JOB SPECIFICATIONS AND CORE COMPETENCIES

Essential Functions

• 40% Ability to respond effectively and timely to inbound calls from provider offices regarding benefits and eligibility, claims processing status, and authorization status.
• 40% Maintains a working knowledge of the claim systems and accurately enters the required information into the designated Customer Relationship Management system (CRM), while adhering to departmental and organizational policies and procedures.
• 10% Maintains a professional behavior and exhibit excellent interpersonal skills

Marginal Functions

• 5% Works collaboratively with coworkers to deliver member/provider services that meet or exceed member/provider expectations
• 5% Other Duties as assigned

Reports to Position Title: Customer Svc Center Supervisor
Employees Supervised Titles: N/A


MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure:

• High School diploma or GED or equivalent

Work Experience (Years and Area):

• Three (3) years Health Care / Plan experience to include Call Center, with claims knowledge. Cross-functionality in Claims, Authorizations, Benefits and Eligibility.

Management Experience (Years and Area): N/A

Software Proficiencies: Microsoft Office (Word, Excel, Outlook)

Other:

Ability to work independently under minimal direction.
Moderate to advanced computer knowledge required.

COMPETENCIES

• Organizational Core Competencies:
• Customer Focus
• Reliability and Dependability
• Honesty & Integrity
• Achievement Orientation
• Change Management
• Team Work

Job Family/Job Title Competencies

• Problem Analysis
• Attention to Detail
• Analytical Thinking
• Responding Sensitively
• Above Average Verbal
• Writing /Composing

INTERPERSONAL SKILLS

• Ensures all interactions are conducive to developing and maintaining a cooperative and productive working environment (both internally and externally).
• Maintains self-control and conducts activities in non-adversarial manner