Customer Service Representative *bilingual preferred* HYBRID

*$1,500 Sign-on Bonus*

POSITION DESCRIPTION

POSITION: Participant Advocate - Customer Service

JOB CLASSIFICATION: Non-Exempt

REPORTS TO: Customer Service Supervisor

JOB SUMMARY – The Participant Advocate will support, promote, and consistently deliver a premier participant experience at all times. During each communication, sincere, empathetic, accurate, and efficient service will be provided. All phone calls, email, and written correspondence with participants, key local union and single employer contacts, providers, vendors, and other participant advocates will be conducted with the utmost of courtesy and professionalism.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• To obtain, accurately interpret, and maintain a thorough working knowledge of all FMCP Summary Plan Description provisions including multiple benefit schedules, as well as a clear understanding of the eligibility system, claim payment system, and the Reciprocity system (ERTS)
• Support, promote, and consistently deliver a premier participant experience
• Respond timely and accurately to phone calls, e-mail, walk in participants, and correspondence by answering questions; explaining claim payments and reason for any claim denials; quote self-payment amounts; verify eligibility and/or benefits; research eligibility or claim issues; update eligibility with outside vendors
• Demonstrate honesty, integrity, compassion, and empathy in all interactions
• Escalate all participant-related concerns to the appropriate individual(s) for timely and accurate resolution
• Document all phone calls accurately and timely in the Customer Service module
• Perform various clerical duties (i.e., enter enrollment forms; process working spouse forms, process special fund claims; process disability claims, etc.).
• Navigate and provide accurate information regarding FMCP website
• Monitor incoming calls and calls waiting via call management system
• Pick up and handle messages from nightline
• Work on special projects as requested by Management
• Other duties as assigned

REQUIRED AND PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES

• Call center experience in a medical insurance call center or medical billing environment, 2 years preferred, or equivalent non-medical call center experience combined with prior medical experience such as LPN, CNA, lab, pharmacy, or radiology technologist, active medical claims processing, or medical coding experience.
• Demonstrate initiative and the drive to serve others, learn, and succeed
• Bilingual Spanish-speaking candidates strongly preferred
• Associate’s degree or equivalent experience required
• Previous major insurance carrier or TPA/JAA experience strongly preferred, but not required
• Prefer experience working for or in service of Taft-Hartley Multi-Employer benefit plans
• Excellent written & verbal communication skills
• Dependability – ensures timely arrival and consistent attendance in support of FMCP participants and the achievement of team goals.
• Proficiency in MS Office is required
• Must type a minimum of 40 wpm
• Demonstrating the ability to manage all issues while maintaining a flexible, positive, caring, and cooperative demeanor
• Responds in a timely manner to operations leaders and stakeholders to facilitate informed decision-making
• Troubleshoots assigned issues, gathers evidence, and investigates all relevant information with participants, vendors, and internal departments to resolve the problem in a cooperative and collaborative manner

WORK SCHEDULE

• In-office - Possible Hybrid schedule after 6 month
• 40 hours, Monday through Friday, with daily 1 hour unpaid lunch

Job Type: Full-time

Pay: From $20.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Are you able to work the scheduled hours of 10 am - 7 pm?

Experience:

• medical insurance company call center: 1 year (Required)

Work Location: In person

Salary : $20