CXO Specialist-Member Service Advocate

GENERAL DUTIES/RESPONSIBILITIES:
1. Demonstrates knowledge in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries; serve as a ‘subject matter expert’ in the healthcare experience that our members navigate daily.
2. Additional subject matter expertise as a senior-level team member in workflows, product and/or business line, region, etc.
3. Conducts member outreach phone calls and/or receiving inbound phone calls within the department’s goal timeframe; successfully contact and manage to the member’s communication preferences as possible, which may include time of day, channel, and language; multi-lingual skills and/or utilize interpreter service as needed.
4. Collaborates with our partners – including other departments, supplemental benefit vendors, and provider network – to facilitate the member experience.
5. Identifies members targeted for care gaps and other campaigns and connect members to programs or services when appropriate; analyze available programs, determine program eligibility, and connect member to appropriate provider or vendor.
6. Responsible for real-time documentation and timely wrap-up to support outcomes reporting in all systems/applications as required; must enter member demographics and information with accuracy and attention to detail, i.e. feel responsible for the quality of our organizational data.
7. Excels in customer service and contribute to a culture of going “above and beyond” to ensure the highest level of member satisfaction.
8. Participates in required team meetings and training and exhibit satisfactory understanding of new information and process.
9. Assist with the development and training of new hires including shadowing.
10. Supports other projects and duties as assigned by Management.
MINIMUM REQUIREMENTS:
Experience:

• Required: Minimum of two (2) years of customer service experience required
• Preferred:

Education:

• Required: High School Diploma or GED.
• Preferred: Bachelor's degree

Specialized Skills:

• Required:
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees
• Knowledge of Medicare Managed Care Plans required
• Intermediate MS Suite knowledge and experience
• Ability to troubleshoot/problem solve
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
• Ability to write routine reports and correspondence
• Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s
• Ability to perform these operations using units of American money and weight measurement, volume, and distance
• Ability to apply common sense understanding to carry out detailed, but un-involved written or oral instructions
• Ability to deal with problems involving a few concrete variables in standardized situations
• Preferred: Bilingual

Other:
May be required to be available to work full-time and over-time through the Annual Enrollment Period (Oct-Dec) and Open Enrollment Period (Jan-Mar)
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
ESSENTIAL PHYSICAL FUNCTIONS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.