Customer Experience Advocate I

About the role

The Operations division is currently seeking multiple talented, curious, and compassionate Customer Experience Advocates (CXA) that are eager to serve as trusted partners in navigating their health insurance needs.

Responsibilities

• Deliver an excellent customer experience for member, provider and other stakeholder inquiries via telephone in a contact center environment, while adhering to a structured schedule and meeting quality, attendance and production standards.
• Strive for first call resolution and de-escalate calls, as necessary.
• Apply customer engagement philosophies and personality-based resolution techniques to all interactions.
• Ensure information about Wellmark’s products and services is clearly communicated by responding accurately, promptly and professionally.
• Develop and maintain positive relationships with members, providers and other stakeholders by using Wellmark-approved methodologies to understand, anticipate, and provide solutions to customer needs.
• Ensure customer records (i.e. claims, membership and/or billing) are processed and updated timely and accurately.
• Research, interpret and educate the customer regarding the claim(s) and determine next steps required in order to accurately process claims and outstanding claims inquiries.
• Develop and maintain a strong business acumen within Wellmark market segments/lines of business and group benefit designs.
• Promote and educate on self-service tools appropriately and accurately.
• Facilitate and teach customers to use appropriate resources/tools and how to access health care information to manage health care costs most effectively.
• Promptly follow up on all inquiries and document resolutions. Responsible for the accurate recording and documentation in Wellmark’s system.

Requirements

• A High School Diploma or GED.
• A minimum of 1 year proven experience engaging with customers (e.g. retail, service, health care provider, nursing, care giver, or teacher).
• Experience in customer-centric role(s) with demonstrated ability to proactively develop professional customer relationships by listening, understanding, anticipating, and providing solutions to customer needs.
• Computer literacy – basic computer skills, such as accessing common web and desktop applications, navigating multiple sources of information and word processing.
• Professional verbal and written communication skills; attention to detail (use of proper sentence structure, proper grammar, with the ability to synthesize member information into a consumable format).
• Good judgment and proven problem-solving skills and ability to think independently.
• Ability to resolve issues and conflicts in a professional manner, while maintaining composure and confidence. Displays empathy and discerns stakeholders’ true intent.
• Collaborates with team members to accomplish goals or outcomes. Builds trust and connects with others, in order to complete work.
• Ability to adapt to an ever-changing work environment; ability to multitask and manage time.
• Basic math skills, including subtraction, addition and multiplication.

Qualifications

• Hands-on experience using AI tools, including effective interaction (prompting), applying human oversight, and validating outputs to ensure accurate, customer-ready information.
• Demonstrated experience working within specified time constraints, such as a structured schedule with adherence goals, etc.
• Prior experience and/or knowledge in health insurance or related industry.

Benefits

• Minimum starting pay of $19.50/hr (Sioux Falls). In addition to base pay, this role offers a broader total compensation package including annual performance incentives, other earning opportunities, and a direct promotion track.
• An opportunity to work hybrid, upon meeting performance and system expectations
• A strong focus on optimizing the customer experience – our mission is to Make Health Care Better!
• A culture of respect, diversity, inclusion, and commitment to our community
• A culture of individuals who are curious, committed, and connected
• A workplace that values health with access to a fitness facility, health programs, education, and services
• An opportunity for career advancement
• Exceptional employee benefits, rewards, and growth opportunities
• Best-in-class tuition assistance program (we will help pay off any current student loans you might have previously incurred!)