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The Customer Care Advocate (CCA) resolves customer inquiries via telephone, walk-in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with LOS, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. The B version of this role requires the individual to speak Spanish fluently.
Provides service among the customers and business partners while responding in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention.
Documents, researches, interprets and responds to inquiries from internal and external customers, business partners and special groups concerning our products, services and policies in accordance with LOS, NCQA, HIPAA, NYSDOH, CMS and other legislative requirements.
Utilizes appropriate resources, resolves customer inquiries accurately & efficiently resulting in acceptable quality, first contact resolution/provider satisfaction, and performance.
Provides outreach related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry.
Demonstrates willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue identification and resolution.
Participates in meetings, training, and skill development to support career path and individual development plans.
Is knowledgeable and enthusiastic about the company and our products and/or services.
Identifies and follows through on issues impacting the Health Plan and customer experience.
Develops effective internal working relationships for improved communication and collaboration.
Shares ideas and solutions to improve processes, procedures, and systems.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular reliable attendance is expected and required.
Performs other functions as assigned by management.
Qualifications
High School diploma or equivalent, customer service experience preferred.
Entry level position. Duties performed under close supervision.
B Version: Bi-lingual English/Spanish required (must have ability to speak Spanish fluently).
Ability to multi-task to efficiently resolve customer concerns, by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously.
Computer skills required, including the ability to navigate in a Windows environment.
Organizational skills, reasoning, problem solving skills, effective and diplomatic communication, ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands.
Successfully attends and completes all training as defined by the business unit.
Requirements
Level II - in addition to Level I requirements:
Rating of “Performing” or above on the Agent Dashboard and Competencies for a minimum of 9 out of 12 months.
Successfully complete training as required by the business unit.
Ability to efficiently resolve complex & escalated issues with minimal direction.
Advanced system and navigational skills.
Expanded communication skills across multiple channels including, but not limited to, voicemail, email, web chat, outbound calls, membership growth, retention, etc.
Takes accountability and ownership of issues and resolution with minimal supervision.
Level III - in addition to Level II requirements:
Rating of “Performing” or above on the Agent Dashboard and Competencies for a minimum 10 out of 12 additional months.
Successfully complete training as required by the business unit.
Self-sufficient in resolving complex & escalated issues.
Provide mentoring and support to new hires and peer group.
Assist with tasks assigned by management that require advanced problem-solving skills.
Demonstrates functional global thinking and takes initiative to recognize opportunities within the team.
Physical Requirements
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
The ability to hear, understand, and speak clearly while using a phone, with or without a headset.
Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
