Advocate4me Customer Care Representative

Reports to: Customer Service Supervisor

Company: Vision Financial Services

Classification: Non-Exempt

Date: October 2024

Position Summary:

Positions in this function provide expertise and customer service support to members of our client at UnitedHealth for the Advocate4Me model.

Responsibilities include direct phone-based customer interaction to address complex member needs and provide recommendations on services that may help close gaps in care for the member and/or the members family. Representatives also authorize claims payments or refer claims to investigators for further review.

This position is full-time (40 hours/week) Monday-Friday. Employees are required to have flexibility to work any of our eight-hour shift schedules during our normal business hours of 8:00am- 8:00pm EST with some holidays, weekends, and overtime as business needs require. Training will be conducted virtually from your home. Employees are required to live in the State of Indiana. Travel is required to the Indianapolis location as needed.

Essential Functions

In our concierge service structure, Representatives’ primary day-to-day function is navigating inbound calls from members, including end-to-end issue identification and resolution.

This role will work one-on-one with assigned eligible members and their caregivers focusing primarily on identification and support of member needs by providing recommendations that help care for the member and/or assist the member’s family. Daily responsibilities include engaging with members through inbound calls, assisting in providing resolution of member issues, and driving positive health outcomes.

Representatives:

• Are best -in-class dedicated customer service agents, providing concierge and white-glove level service; removing burdens; and providing end-to-end resolution for customers.
• Manage members issues to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
• Communicate with members and their care givers regarding anticipated member service needs and resolution of issues;  research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs.
• May be asked to work independently after hours to resolve urgent issues that surface after normal business hours. This role has the ability to work outside of established procedures to ensure high-level member satisfaction.
• Identify gaps in processes and work closely with other departments for process improvement
• Provide education and status on previously submitted pre-authorizations or pre-determination requests, as appropriate.
• Ability to handle high-pressure
• Apply conflict management skills, including the ability to remain calm and composed while de-escalating conflict.
• Dynamic work environment with demanding expectations.

Competencies

Employees will train to gain proficiency in member tools, benefit interpretation, and complex issue management to interpret situations and proactively address complex member issues.

Representatives must be able to:

• Focus on managing Inbound calls, with only occasional Outbound calls as needed to resolve issues.
• Quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations; responding in a respectful, timely manner; and delivering on commitments
• Listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member
• Apply critical thinking skills to negotiate complex health scenarios
• Provide necessary feedback and identify root cause to other call center agents, departments, and leaders to ensure process improvement
• Utilize multiple systems/platforms while on a call with a member, applying strong computer skills and technical aptitude.
• Customize approach to meet all types of member communication styles and personalities
• Apply excellent conflict management skills, including professionally and adeptly resolving issues while under stress; remaining calm and composed under pressure to work through issue with difficult interactions; and diffusing conflict and member distress
• Demonstrate emotional resilience.
• Consistently delivering excellent service to members under challenging and difficult circumstances
• Effectively communicate verbally and in written form, with a strong attention to detail
• Possess solid time management skills.

Supervisory Responsibility

This position has no supervisory responsibilities.

Work Environment and Physical Demands

• The job operates as a hybrid/work from home environment.
• Frequent speaking; listening, using a headset; sitting; use of hands/fingers across keyboard or mouse; handling other objects; long periods working at a computer.
• Ability to work regularly scheduled shifts within our hours of operation and scheduled lunches and breaks and the flexibility to adjust daily schedule, working over-time and/or weekends as needed.

Position Type and Expected Hours of Work

This is a full-time position.

Shifts are scheduled at times when the Call Center is open Monday through Friday, 8:00 a.m. to 8 p.m. Eastern time. Evening and weekend work may be required as job duties demand and for team meetings.

Travel

Travel to the Indianapolis office as needed, hybrid. Or as dictated by business needs.

Required Education and Experience

• At least one year of experience in an Advocate Role supporting one or more of the following products: Health Care/Insurance environment, Medicare, Medicaid, Inbound/Outbound Call Center experience
• High school diploma or GED and at least one years’ work or volunteer experience in coaching and guiding internal or external customers (customer service)

Preferred Education and Experience

• Associate degree and at least two years’ work or volunteer experience in coaching and guiding internal or external customers (customer service)
• Bachelor’s degree and at least six months’ work or volunteer experience in coaching and guiding internal or external customers (customer service)
• Health Care/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design) Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Job Type: Full-time

Pay: $19.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• On-the-job training
• Paid time off
• Vision insurance
• Work from home

Shift:

• Day shift
• Evening shift
• Night shift

Education:

• High school or equivalent (Required)

Experience:

• Inbound/ outbound call center: 1 year (Required)
• Medicaid, Medicare insurance: 1 year (Required)

Location:

• Indianapolis, IN (Required)

Shift availability:

• Night Shift (Required)
• Day Shift (Required)

Ability to Commute:

• Indianapolis, IN (Required)

Work Location: Remote