Customer Service Advocate I (WV-EG)

Resp & Qualifications

PURPOSE:
Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications. 

ESSENTIAL FUNCTIONS:

• Provides first- level problem resolution to member,  provider & broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures.

• Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. Appropriately documents all client interactions according to established departmental procedures.

• Delivers accurate information to customers in accordance with performance goals and objectives.

• Maintains customer records by updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes.

• Participates in ongoing education related to new services, industry topics, and skills

SUPERVISORY RESPONSIBILITY:
Individual Contributor 


QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The
requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: High School Diploma OR GED

Experience: less than one year customer service experience

Knowledge, Skills and Abilities (KSAs)

• Successful completion of the training provided.
• Demonstrated skills as an empathetic and compassionate communicator.
• Ability to quickly gain customer trust and confidence.
• Demonstrated PC navigation and data entry skills.,
• Strong interpersonal communication skills.
• Good oral and written communication skills.
• The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Department

Department:  Service 

Equal Employment Opportunity

CASCI is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.cascicareers.com

Where To Apply

PeopleSoft/Self Service/Recruiting

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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