Member Services Advocate

Member Service Advocate Location: Remote Responsibilities Serve members by acting as an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims, and other aspects of plan benefits and services. Provide quality customer service by applying SCAN Five Service Principles. Educate members, family, providers and caregivers regarding benefits and plan options; accurately explain benefits and plan options in person, via email or telephone. Provide follow‑up with members by clarifying the customer’s issue, determining the cause, and explaining the solution. Escalate appropriate member issues to management or other departments as required. Consistently meet or exceed departmental standards, including quality, productivity, adherence to schedule and attendance. Respond appropriately and in a timely fashion to member, internal staff and provider inquiries concerning benefits, eligibility, referrals, claims and other issues following departmental policies, procedures and job aids. Takes ownership of the issue, focusing on providing solutions and options for members throughout the resolution process. Increase member satisfaction by following up and resolving member issues, complaints and questions efficiently, accurately, and timely; coordinate resolution with providers and other departments as needed. Participate in member calling projects assigned by management to support the overall SCAN goal of membership retention. Follow policies, procedures and job aids to maintain efficient and compliant operations; communicate suggestions for improvement and efficiencies to management; identify and report workflow problems following proper departmental procedures. Actively participate in departmental staff meetings and training sessions. Follow all applicable Federal and State regulatory requirements and guidelines for Scan Health Plan operations as documented in company policies and procedures. Follow all HIPAA requirements. Document transactions by completing applicable member forms and summarizing actions in the appropriate computer system, following departmental or other authorized standards. Temporarily respond to routine member questions and concerns on specific medical group call queues as part of skill development. Contribute to team effort by accomplishing related results as needed. Actively support the achievement of SCAN’s Vision and Goals. Qualifications 1–2 years call center or related customer service experience, required. 1–2 years of prior experience with Medicare benefits, including Medicare Advantage Plans preferred. Experience in the healthcare, insurance or pharmacy industry highly desirable. Ability to maintain a calm demeanor at all times, including during highly charged situations. Data entry and general computer skills (word processing, e‑mail), required. Effective oral and written communication skills. Professional and pleasant telephone manner, required. Ability to handle large call volume while providing excellent customer service at all times. Demonstrated efficiency and effectiveness in an environment with a high call volume. Benefits Base Pay Range: $20.00–$21.50 Work Mode: Remote Annual employee bonus program Robust wellness program Generous paid‑time‑off (PTO): 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days Excellent 401(k) retirement saving plan with employer match Robust employee recognition program Tuition reimbursement Opportunity to be part of a team that makes a difference to our members and our community every day Equal Employment Opportunity At SCAN we are proud to be an Equal Employment Opportunity and affirmative action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, marital status, disability, protected veteran status or any other status protected by law. A background check is required. We also prohibit discrimination for employees who inquire about pay or the pay of others. #J-18808-Ljbffr