Consumer Services Advocate

Job Description

Job Description

Job Title: Consumer Service Advocate

Business Unit: Administration

Department: Consumer Services Unit

Reports to: Senior Provider Relations and Consumer Services Manager

FLSA: Non-Exempt

Classification: Regular Full-time (35 hours)

Grade Level: 7

Salary Range: $ 35,747 - $44,684 (commensurate with experience)

SUMMARY OVERVIEW

The Customer Service Advocate (CSA) plays a vital role to Boston Senior Home Care, Inc., both externally to the community as well as internally to the staff. The CSA works within a team to initially manage consumer inquiries in an efficient manner, properly addressing a consumer's need regarding programs, services and referrals. If required, challenging questions will be escalated accordingly and other inquiries will be transferred to respective program staff. The CSA will work with BSHC field staff and providers on a daily basis to follow and implement service plans; such as schedule changes, suspensions, resumptions, implementation of new services, changing providers, case closures and transfers as requested by the program's staff.

ESSENTIAL FUNCTIONS

Essential Job functions: Duties _______ through _______are designated as ADA Essential Functions and must be performed in this job. All other job duties are secondary functions. [TBD]

1. Respond to and resolve on the first call, consumer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, and other types of correspondence.
2. Help guide and educate consumers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider.
3. Help Care Managers to schedule providers on behalf of the consumer to assist with the services when needed.
4. Own requests through to resolution on behalf of the consumer in real time or through comprehensive and timely follow-up.
5. Research complex issues across multiple databases and work with Care Managers to resolve consumer issues and/or partner with others to resolve escalated issues.
6. Assist Care Managers in resolving provider billing discrepancies every month.
7. Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance.
8. Additional administrative office service duties as assigned: Answer, screen and route calls in a friendly, courteous, and professional manner. As needed, take accurate messages for staff not available by phone and forward them to voice mail. Greet visitors and notify appropriate staff person. Be a resource for staff, callers and visitors.
9. Act as liaison for department and Office Resources.

COMPETENCIES

• Excellent organizational and analytical skills
• Exceptional over the phone customer service skills with strong attention to detail and patience to walk through caller questions
• Excellent problem-solving skills
• Demonstrated computer proficiency. Must be capable of working with a high degree of independence, using good judgment to anticipate and resolve issues as they arise
• Strong written, interpersonal, and presentation skills that convey a positive attitude and build relationships with clients and coworkers in an urban, multi-ethnic and racially diverse environment.
• Strong mathematical skills
• Thorough knowledge of office practices, management, organization
• Strong time management and priority settings skills with the ability to handle diverse responsibilities and work independently with minimal supervision
• Work with a high degree of independence, must have good judgment to anticipate and resolve issues as they arise

SUPERVISORY RESPONSIBILITY

This position has no supervisory responsibilities.

WORK ENVIRONMENT

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, printers, copiers, filing cabinets.

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.

• The employee must be able to carry 10 to 15 lbs
• The employee is regularly required to talk and hear
• The employee is frequently is required to stand, walk, use hands to finger, handle or feel, and reach with hands and arms

POSITION TYPE/EXPECTED HOURS OF WORK

This is a full-time position, Monday-Friday, 9:00 AM - 5:00 PM

TRAVEL

This position requires minimal travel.

REQUIRED/PREFERRED EDUCATION AND EXPERIENCE

• An Associate's degree is preferred or at least 2-3 years of relevant customer service experience in a health and human services organization
• Customer service experience a plus
• Strong computer knowledge, skilled in Microsoft office programs, and proficient typing
• Ability to work in a fast-paced and changing environment
• Must be able to work in a team-oriented environment

ADDITIONAL ELIGIBILITY QUALIFICATIONS

• Sensitivity to older adult, disability and diversity issues
• Commitment to maintaining members at home with dignity

WORK AUTHORIZATION/SECURITY CLEARANCE

• Must be able to work in the United States

AAP/EEO STATEMENT

Equal Employment Opportunity/Affirmative Action/Male/Female/Veteran/Disabled – Boston Senior Home Care affirms and supports diversity and inclusion in our workforce and recognizes all EEOC Factors.

OTHER DUTIES

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Given the nature of the organization and the population it serves, all new employees are required to clear a CORI prior to taking on a new role.