Customer Care Advocate IA - Utica/Albany areas

Summary The Customer Care (CC) Advocate resolves customer inquiries via telephone, walk-in, mail, fax, web chat, off‑phone work, and email concerning contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. The Advocate provides service for customers and business partners while responding professionally, efficiently, and timely to resolve issues and enhance member and provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently. Essential Responsibilities & Accountabilities Provide service to customers and business partners in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention. Document, research, interpret, and respond to inquiries from internal and external customers, business partners, and special groups concerning our products, services, and policies in accordance with MTM, NCQA, HIPAA, NYSDOH, CMS, and other legislative requirements. Utilize appropriate resources to resolve customer inquiries accurately and efficiently, achieving acceptable quality, first‑contact resolution, and performance. Provide outreach related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry. Demonstrate willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue identification and resolution. Participate in meetings, training, and skill development to support career path and individual development plans. Be knowledgeable and enthusiastic about the company and our products and/or services. Identify and follow through on issues impacting the Health Plan and customer experience. Develop effective internal working relationships for improved communication and collaboration. Share ideas and solutions to improve processes, procedures, and systems. Consistently demonstrate high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and the Lifetime Way values and beliefs. Maintain high regard for member privacy in accordance with the corporate privacy policies and procedures. Maintain regular, reliable attendance. Perform other functions as assigned by management. Minimum Qualifications NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Level I High School diploma or equivalent required. Customer service experience preferred. Entry level position. Duties performed under close supervision. Attends all training required to become proficient in position. B Version: Bi‑lingual English/Spanish required (must have ability to speak Spanish fluently). Ability to multi‑task in order to efficiently resolve customer concerns, actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously. Excellent computer skills required, including the ability to navigate in a Windows environment. Skilled at working between multiple programs and applications at the same time. Adept at communicating effectively and diplomatically while working as a collaborative team member. Organizational, reasoning, and problem‑solving skills. Strong organizational skills and ability to prioritize, multitask, and work in a fast‑paced environment and remain professional and focused under multiple pressures and demands. Completed training on at least one part of Scheduling unit. Level II – In addition to Level I Rating of “Performing” or above on the Agent Dashboard and Competencies for a minimum of 9 out of 12 months. Completed training on all parts of scheduling unit. Ability to efficiently resolve complex & escalated issues with minimal direction. Advanced system and navigational skills. Expanded communication skills across multiple channels including, but not limited to, voicemail, email, web chat, outbound calls, membership growth, retention, etc. Takes accountability and ownership of issues and resolution with minimal supervision. Dental & Medical Intake Units Specific: Rating of “Performing” or above on the Agent Dashboard and Competencies for a minimum of 9 out of 12 months. -OR- Move to & complete training for Commercial Unit. Level III – In addition to Level II Rating of “Performing” or above on the Agent Dashboard and Competencies for a minimum 10 out of 12 months. Self‑sufficient in resolving complex & escalated issues. Provide mentoring and support to new hires and peer group. Assist with tasks assigned by management that require advanced problem‑solving skills. Demonstrate global thinking and take initiative to recognize opportunities within the team. Dental & Medical Intake Units Specific: There is no Level III option for these two units. Must move to Commercial unit to continue level progression. Commercial Unit Specific: Rating of “Performing” or above on the Agent Dashboard and Competencies for a minimum of 10 out of 12 months. -OR- Move to & complete training for Dedicated Unit. Physical Requirements Work is completed in a traditional office environment under fluorescent lighting. Ability to arrive on time at work and as scheduled. Ability to meet minimum performance metrics. Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time. Must be able to travel across the enterprise. Regularly required to talk. Regularly required to hear. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s) Grade N2: Minimum $18.22 - Maximum $23.89 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case‑by‑case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. #J-18808-Ljbffr Excellus BCBS