Member Services Advocate

Member Service Advocate Location: Remote Our organization, SCAN, is a nonprofit health organization dedicated to improving care for older adults across the United States. We are seeking a Member Service Advocate to serve as an advocate and point of contact for members regarding benefits, eligibility, referrals, claims, and other plan benefits and services. Responsibilities Serve members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims, and other aspects of plan benefits and services. Ensure member satisfaction by providing superior customer service and willingness to help at all times while maintaining a professional demeanor. Apply SCAN Five Service Principles to deliver quality customer service. Educate members, family, providers, and caregivers regarding benefits and plan options. Accurately explain benefits and plan options in person, via e‑mail, or telephonically. Provide follow‑up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalate appropriate member issues to management or other departments as required. Consistently meet and/or exceed departmental standards, including quality, productivity, and adherence to schedule and attendance. Respond promptly to member, internal staff, and providers through telephone and written inquiries concerning benefits, eligibility, referrals, claims, and other issues in accordance with departmental policies and procedures. Took ownership of issues to provide solutions and options for members, as necessary, through issue resolution. Increase member satisfaction by following up and resolving member issues, complaints, and questions efficiently, timely, and accurately; coordinate with providers and other departments as needed. Participate in member calling projects as assigned by management to support membership retention. Follow policies and procedures and job aids for efficient operations; communicate suggestions for improvement and efficiencies to management; identify and report workflow problems following proper 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 HIPAA requirements. Document transactions by completing member forms and summarizing actions taken in the computer system. 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 of 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 communication skills (oral and written). Professional and pleasant telephone manner (required). Ability to handle large call volume while delivering excellent customer service at all times (required). Demonstrated efficiency and effectiveness in an environment with high call volume. Background check required. Benefits Base Pay Range: $20.00–$21.50 per hour. Work Mode: Remote. Annual employee bonus program. Robust wellness program. Generous paid‑time‑off: 11 paid holidays per year, one floating holiday, birthday off, and two volunteer days. Excellent 401(k) retirement 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 community every day. Equal Employment Opportunity 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 (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, marital status, disability, protected veteran status, or any other status protected by law. A background check is required. #J-18808-Ljbffr SHPCA SCAN Health Plan