Customer Service Advocate Jobs

Company:

AHI agilon health, inc.

Location:

Remote - HI

Job Title:

Customer Service Advocate

:

Position Summary:

The Customer Service Representative communicates with a diverse constituency of internal and external customers and responds to individual questions and concerns specific to organizational determinations, claims, plan benefits, coverage determinations, disputes, and questions or issues related to payment methodology. Receives and responds to calls from providers and members. Transfers calls as necessary to applicable department, such as, but not limited to, utilization management, or to applicable Health Plan as appropriate. Conducts inquiries and research related to provider and member questions and concerns, including claims and authorization status and related information, and documents all calls and responses. Relays plan contact information to providers and members as applicable and appropriate.

Essential Job Functions:

• Responds to provider dispute queries.
• Answers calls timely and in accordance with the performance standards established within the customer service department.
• Provides plan contact information as applicable to members and providers.
• Ensures confidentiality of all hard copy, electronic, and verbal communication, and adheres to organization’s policies related to privacy and disclosure.
• Performs other duties as assigned.
• Provides information as requested related to coverage determinations and appeals processes.
• Receives inbound calls and responds appropriately to provider, or member, questions and/or concerns.
• Forwards calls as appropriate to supervisor or other staff for further response or follow up.
• Verifies claims status and coordinates information, as applicable, with provider and claims staff.
• Facilitates communication through the Language Assistance Program (for members who are not English proficient) of the various plans, and/or arranges for interpreter, including interpretive services for the hearing impaired.
• Provides information as requested by caller related to claims and authorizations.
• Maintains applicable and timely records and files regarding member and provider communications and service coordination.
• Facilitates provider and member communications related to network providers.
• Promotes a positive image of the organization and the department in all aspects of communication and contact.
• Reviews all documents received for completeness, verifies eligibility member

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.
• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
• Engage in excellent communication which includes listening attentively and speaking professionally.
• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Demonstrate attention to detail and accuracy in work product.
• Set and complete challenging goals.

Required Qualifications:

Minimum Experience

• Experience in a managed care environment preferred.
• Demonstrated experience and expertise in customer service skills: excellent verbal and written communication skills, handling difficult communications with skill to achieve positive outcome, clear and concise targeted communications focused on the customer (verbiage, language, style, etc. all may vary depending on the customer/audience).
• Previous experience in Customer/Member services or related function in health care organization preferred.
• Bilingual (English/Spanish) preferred

Education/Licensure:

• Minimum educational level, high school diploma. Some college level course work preferred.