Hours: Monday - Friday 8:00am-4:30pm (one weekend per month)

Job Summary

Member Advocates are the main point of contact at Clever Care; interfacing with members, prospective members, providers, brokers, and vendors. Serves members by being the main point of contact at Clever Care for member questions and concerns regarding benefits, eligibility, referrals, claims, and any other aspects of plan benefits and services. A successful Member Advocate I ensures member satisfaction by providing superior customer service and displaying a willingness to help at all times while maintaining a professional demeanor.

Member Services Representatives are expected to assess the needs of the caller and determine, based on strong operational understanding, the most appropriate and effective course of action.

Functions & Job Responsibilities

• Educates members, family, providers and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email, fax, or telephonically.
• Provides follow-up with members by clarifying the customer's issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.
• Provides follow-up with members by clarifying the customer's issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.
• Participates in member calling projects as assigned by management to support the overall Clever Care goal of membership retention.
• Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Clever Care Health Plan operations, as documented I company policies and procedures. Follows all HIPAA requirements.
• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
• Ability to work in an environment where continuous coaching and feedback is the standard practice.
• Other duties as assigned

Qualifications

Education and Experience:

• High School Diploma or equivalent required.
• Bachelor's Degree or equivalent work experience preferred
• Two (2) years Customer Service experience preferably in healthcare management and/or a call center setting

Skills:

• Familiarity with Centers for Medicare and Medicaid Services (CMS) regulations
• Bilingual in Cantonese, Mandarin, Vietnamese, Korean, Spanish, Thai, Khmer, Japanese may be required.
• Exceptional customer service skills, including verbal and written communication
• Strong active listening skills
• Ability to collaborate and be a team player
• Must be a quick learner
• Ability to remain calm and courteous when handling upset members and offering solutions to their problems and knowing when to escalate the call
• Ability to listen, talk, and type at the same time.
• Proficiency with Microsoft Office (Word, Excel, Outlook)
• Type 40 wpm. 60 wpm preferred

Other:

• Must be willing and able to work some weekends from October-March