Member Services Advocate

Company Convey – US Job Description Receive inbound calls from members who are enrolled in Cigna. Assist beneficiaries with a wide range of critical services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan. Place outbound calls as directed and necessary for member resolution. ESSENTIAL DUTIES AND RESPONSIBILITIES Update account information such as billing options and changes of address or phone numbers. Research premium billing discrepancies and prescription claims processed. Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage. Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why. Display positive demeanor, technical accuracy, and conformity to company policies. Ensure HIPAA regulations are maintained within the immediate environment. Responsible for concise and detailed notations as it pertains to member records. Handle outbound calls for purposes of validating information. Handle inbound calls by assisting members with a high level of accuracy and efficiency. Escalate any member issues to management as necessary. Maintain a high level of call quality as set by client standards, which includes a 95% quality score, and answer 80-85% of calls within 30 sec or less. Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner. Conform with and abide by all regulations, policies, work procedures and instructions. Respond promptly when returning telephone calls and replying to correspondence and faxes. Act, dress, and behave in a professional manner to reflect a positive image of the company. #J-18808-Ljbffr