Customer Service Advocate

POSITION DUTIES & RESPONSIBILITIES

• Serves as an advocate for members, to assist with inquiries regarding referrals and prior authorizations, AZPC’s provider network, appeals and grievance processes by addressing questions or concerns.
• Processes complaints and research issues; working with appropriate internal and external partners.
• Respond to Customer inquiries via telephone (and written correspondence) with focus on resolving issues on the first call, utilizing reference materials and available resources to identify the status of the issue and provide appropriate response to the caller.
• Support outbound calls and call campaigns as needed.
• Provide assistance to health care professionals, vendors, and AZPC Health Plan partners; verify patient eligibility, provide claim payment and referrals/prior authorization status, and collaborate with our partners (including but not limited to) other departments, Health Plans, and provider network to facilitate the member experience.
• Deliver information and answer questions in a positive, conversational and compassionate manner while excelling in customer service to contribute to a culture of going “above and beyond” to ensure a high-level member satisfaction.
• Gather necessary, relevant information and complete documentation necessary to track issues and inquiries into Customer Service application.
• Provide follow-up contact with members and providers to ensure timely resolution and customer satisfaction.
• Aid members and/or providers regarding website information and navigation.
• Identify trends related to incoming or outgoing calls to support excellent customer service, quality improvement, call reduction and issue resolution, escalating issues to management as deemed appropriate.
• Consistently achieve department goals established for the position in the areas of quality, performance, efficiency, first call resolution and attendance; essential to the member and provider experience.
• Strong listening skills are essential; to give full attention to understanding the customer needs.
• Critical thinking, problem solving, decision-making; necessary to ensure the best solutions and resolution to customer problems and strong communication in line with member’s communication preferences.
• Act as a “subject matter expert” – Knowledgeable in procedures, protocols, benefits, services, and resources to resolve member issues and inquiries.
• Real-time documentation; enter member demographics and information with accuracy and attention to detail.
• Strong computer skills; ability to multi-task and navigate multiple Windows applications while communicating and documenting accurate, relevant information.
• Perform other duties as assigned, including but not limited to, special projects, outreach initiatives, administrative duties, receptionist desk support, etc.

Education, Training And Experience

• High school diploma or equivalent – Some college preferred.
• Prior experience in customer service.
• Knowledge of Medicare, managed care systems, and medical terminology preferred.
• Excellent written and oral communication skills.
• Ability to interact with providers and patient in a professional manner with a strong commitment to positively representing the company.
• Ability to function in a high stress environment.
• Familiarity with computer and Windows PC applications and the ability to multi-task and navigate a computer while on the phone.