Customer Service Advocate, Healthcare Insurance Albuquerque NM Metro Area - UnityBPO : Job Details

Apply only if you reside in Albuquerque New Mexico Metro Area UnityBPO is seeking a Health Plan Benefits professional for a customer service Call Center Representative position. The ideal candidate should be engaging, dynamic, and possess strong analytical skills along with an exemplary attendance record. Experience with health plan benefits is essential, as is the ability to communicate plan policies and benefits clearly and effectively.MUST BE BILINGUAL - ENGLISH/SPANISH PROFICIENT Call Center Reps are responsible for providing comprehensive high-quality service to all customers. The primary responsibilities include but are not limited to documenting all customer contacts into the tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientations, claims review inquiries, etc.Requirements

• High School diploma or G.E.D. equivalent; and
• 2 -3 years' experience in a call center customer service role with medical and or insurance terminology.
• Proven ability to provide exemplary service to customers in healthcare-related sectors, such as insurance, physician offices, and medical clinics.
• Ability to maintain composure and professionalism while addressing challenging situations and managing potentially upset customers.
• Proficient in simultaneous talking and typing, with a strong emphasis on attention to detail.
• Excellent written and verbal communication skills on skills.
• Ability to adapt to an ever-changing environment.
• Familiarity and ability to use multiple systems such as Salesforce, Genesys PureCloud, Wiki, etc.

Job Description

• Assist members with selecting a Primary Care Physician (PCP) and locating providers and vendors within the plan's network.
• Provide members with eligibility information, assist in understanding Explanation of Benefits (EOB) statements, and address inquiries related to claims and appeals status.
• Record and respond to all Customer contacts, ensuring updates are made in tracking systems; manage and ensure appropriate follow-up and resolution for all customer interactions.
• Conduct proactive outreach to customers through multiple channels including phone, email, text, and chat, particularly concerning new member orientation.
• Address disenrollment requests while proactively engaging in retention efforts.
• Accurately research and respond to all customer inquiries concerning eligibility, benefits, services, claims, and authorizations.
• Process requests for member materials, such as ID cards, member guide, provider directories , etc.
• Verify and update member demographic information as necessary.
• Clearly and concisely classify and record all customer interactions.
• Identify and escalate complex issues while providing thorough follow-up and resolution .
• Aim for first call resolution by addressing member and provider issues effectively as the primary point of contact.
• Utilize dual monitors and computer-based resources efficiently to assist in answering customer inquiries.
• Maintain a strong attention to detail and ensure a high level of accuracy in all tasks .
• Successfully meet key performance indicators and service standards.

Disclaimer

• The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification/job function.
• It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.
• The preceding job description does not alter the at will status and therefore does not constitute a contract of employment, expressed, or implied between any employee and UnityBPO.

We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.Salary Description $17 DOE