• 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