* To be considered, please ensure you live within a reasonable commuting distance of Temple, TX
** Interviews are underway and the targeted start date for this class is, February 10, 2025
*** If selected, the onsite training hours will be from 8am to 5pm Mon through Fri, for 8 weeks in total
**** Upon completion of training, you will work a total of 40 hours per week and your 8-hour shifts will be scheduled anytime between 7am and 5pm, Monday through Friday

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JOB SUMMARY

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The Customer Advocate 1, under general supervision, communicates to Members and Providers policy and procedures and services of the Health Plan (Plan), and handles any complaints concerning the Plan by the membership. This position works on the Members behalf to resolve any issues and concerns by going the extra mile, when needed.

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ESSENTIAL FUNCTIONS OF THE ROLE

\n\nUnder general supervision, communicates to Members and Providers policies, procedures and services of the Plan to ensure complete knowledge of the Plan. Helps Members with access to the Plan system, and helps members pick an appropriate physician, and help with appointments.\nMust adhere to call handling goals of 80% of calls answered within 30 seconds. Helps and adheres to call abandonment rate of less than five percent (5%) with average hold time not to exceed 2 minutes based on regulatory requirements. Within 60 days of employment on the floor, must meet monthly quality goal of ninety-two percent (92%) or greater based on two percent (2%) of calls monitored. Helps and meets schedule adherence goals based on department policy successful completion of proficiency testing following initial Advocate training.\nServes as a primary contact for benefits, claims status and simple drug inquires for Personal Plans with working knowledge of other products, based on first contact resolution guidelines. Verifies demographic information on all inquiries and updates the Plan system.\nHelps Members with concerns and effectively works toward a resolution before the concern escalates to a complaint.\nAccesses appropriate sources to obtain benefit information requested by Member and Providers.\nActs as liaison between Members, Providers and billing offices, with follow through to resolve issues.\nAccurately documents phone log records for each inquiry with appropriate messaging based on department standards.\n\n

KEY SUCCESS FACTORS

\n\nRequires successful completion of proficiency testing following initial Advocate training.\nMust successfully complete Customer Service training and successfully pass proficiency exam to maintain CSA position.\nMust successfully complete spelling, grammar and basic computer skills testing during job interview.\nMust be proficient in typing and basic computer skills.\nPerform well in a fast-paced, stressful routine work environment.\nMust have good phone etiquette and uses effective communication skills (both verbal and written).\nMust be familiar with policies, procedures and new products offered by Marketing and completes training as required.\nMust be able to multi-task.\nMust be knowledgeable in public relations with a diverse customer base.\nMust be able to problem solve and act as advocate for the customer.\n\n

BENEFITS

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Our competitive benefits package includes the following

\n\nImmediate eligibility for health and welfare benefits\n401(k) savings plan with dollar-for-dollar match up to 5%\nTuition Reimbursement\nPTO accrual beginning Day 1\n\n

Note: Benefits may vary based on position type and/or level

QUALIFICATIONS

\n\nEDUCATION - H.S. Diploma/GED Equivalent\n EXPERIENCE - 1 Year of Experience\n