Customer Care Advocate (Customer Care Representative)

Summary The Customer Care Advocate (CCA) resolves customer inquiries via telephone, walk‑in, mail, fax, web chat, off‑phone work, and e‑mail concerning contract benefits, claim payments, and enrollment in accordance with LOS, Corporate Service strategy, NCQA, and legislative requirements. The CCA provides service for customers and business partners while responding professionally, efficiently, and timely to enhance member and provider satisfaction/retention. The B version of this role requires fluency in Spanish. Essential Responsibilities / Accountabilities Provides customer service to customers and business partners across all communication channels. Documents, researches, interprets, and responds to inquiries in line with LOS, NCQA, HIPAA, NYSDOH, CMS, and other regulatory requirements. Utilizes appropriate resources to resolve customer inquiries accurately and efficiently, achieving first‑contact resolution and provider satisfaction. Provides outreach related to claims, onboarding, effectuation, retention, and provider inquiries. Demonstrates flexibility, adapts to change, and takes ownership of issue identification and resolution. Participates in meetings, training, and skill development to support career path and personal growth. Showcases knowledge and enthusiasm about the company and its products/services. Identifies and follows through on issues impacting the Health Plan and customer experience. Develops effective internal working relationships to enhance communication and collaboration. Shares ideas and solutions to improve processes, procedures, and systems. Demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission, values, and Corporate Code of Conduct. Maintains strict regard for member privacy in accordance with corporate policies. Ensures reliable attendance and performs other functions as assigned. Minimum Qualifications Level I: High School diploma or equivalent; customer service experience preferred; entry‑level position with duties performed under close supervision. B Version (Bilingual): English/Spanish fluency; ability to multi‑task—listen, navigate screens, type documentation, and speak simultaneously; computer skills in a Windows environment; organizational, reasoning, problem‑solving, communication, prioritization, and multitasking skills; completes all required training. Level II: All Level I and B Version requirements; rating of “Performing” or above on Agent Dashboard and Competencies for at least 9 of 12 months; complete required training; efficiently resolve complex and escalated issues with minimal direction; advanced system navigation; expanded communication skills across multiple channels; takes accountability with minimal supervision. Level III: All Level I, B Version, and Level II requirements; rating of “Performing” or above for at least 10 of 12 additional months; complete required training; self‑sufficient in resolving complex and escalated issues; provide mentoring and support to new hires and peers; assist with advanced problem‑solving tasks; demonstrate global thinking and initiative within the team. Physical Requirements Work while sitting and/or standing at a workstation, viewing a computer, using a keyboard, mouse, and/or phone for three or more hours at a time. Ability to hear, understand, and speak clearly while using a phone, with or without a headset. Ability to travel across the Health Plan service region for meetings and/or trainings as needed. Equal Opportunity Employer 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. Competitive Compensation & Benefits Grade N2: Minimum $20.00 – Maximum $20.00 . The salary range represents the minimum and maximum of the salary range for this position. Actual salary will vary based on budget, experience, and other factors. Total rewards include group health and/or dental insurance, retirement plan, wellness program, paid time away, and paid holidays. Remote Work There may be an opportunity for remote work within all jobs posted by the Talent Acquisition team. This decision is made on a case‑by‑case basis. Americans with Disabilities Act Statement In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. #J-18808-Ljbffr Capital District Physicians Health Plan, Inc.