Customer Experience Advocate

Job Description

Job Description

Position Summary:

Responsible for providing professional, responsive, and compassionate customer service to members and providers through telephone and other communication channels. This position serves as a front-line resource for questions related to health plan benefits, eligibility, claims, referrals, authorizations, and other member or provider concerns. The Customer Experience Advocate researches and resolves issues, when possible, provides accurate information and education, and coordinates with internal departments to support timely resolution and a positive customer experience.

Essential Duties and Responsibilities:

1. Thoroughly understands the managed care philosophy and the company’s products. 
2. Receives and responds to member and provider phone calls/inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
3. Receives, records, and resolves member complaints and problems. 
4. Answer calls in a pleasant and courteous manner within 30 seconds. 
5. Routinely accesses member information via multiple computer systems. 
6. Accurately documents member and provider contacts on the computer system. 
7. Responsible for ensuring that members receive accurate and complete information. 
8. Communicates effectively and professionally with members, providers, and state agencies. 
9. Screens telephone calls and directs to the appropriate area or person as necessary. 
10. Acts as a liaison between members, physicians, and health plan. 
11. Research member concerns and attempts to resolve issue during call. 
12. Works in coordination with other departments concerning member and provider issues. 
13. Prepares documentation and reports for review by the Customer Services Director and Supervisor. 
14. Maintains confidentiality per HIPAA guidelines.
15. Proactively educate members regarding care gaps.
16. Coordinate care to assist members
17. Identifies and proactively escalates member retention risks.
18. Completes onboarding of new members 

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

  Qualifications: 

• High school diploma or general education degree (GED). 
• Bilingual English/Spanish
• Knowledge of word processing, spreadsheet, internet, and other computer applications. 

Preferred Qualifications: 

• Experience in healthcare, health insurance, managed care, or related healthcare environment 
• Experience working with customer/member inquiries, complaints, benefits, eligibility, referrals, authorizations, or other healthcare-related services 
• Experience with Epic or other healthcare information systems
• Minimum of two (2) years of customer service experience

  Skills and Abilities: 

• Excellent verbal and written communication and active listening skills. 
• Strong customer service and problem-solving skills, with the ability to research and resolve customer concerns. 
• Ability to handle multiple systems and tasks simultaneously while maintaining accuracy. 
• Strong attention to detail and ability to accurately document customer interactions and information. 
• Ability to remain professional and composed when handling complaints, sensitive situations, or challenging interactions. 
• Ability to establish and maintain effective working relationships with members, providers, internal departments, and other stakeholders. 
• Ability to understand and communicate information clearly while maintaining confidentiality and HIPAA requirements. 
• Ability to work independently while also collaborating effectively within a team.

Work Schedule:

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands: 

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. A reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment: 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. A reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

Background Screening Notice:
In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.

Additional information is available at: ???? 

Work Schedule:
Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.
Monday through Friday, Day Shift