Member Services Advocate

About the role

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

Responsibilities

• Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services.
• Ensures member satisfaction by providing superior customer service and willingness to help at all time while maintaining a professional demeanor.
• Provides quality customer service by applying SCAN Five Service Principles.
• Educates members, family, providers and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email or telephonically.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution.
• Escalates appropriate member issues to management or other departments as required.
• Maintains a professional demeanor and provides excellent customer service at all times.
• Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids.
• Takes ownership of the issue, focusing on providing solutions and options for member, as necessary through resolution of member issue.
• Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed.
• Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention.
• Follows policies and procedures and job aids in order to maintain efficient and compliant operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Scan Health Plan operations, as documented in company policies and procedures.
• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
• Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development.
• Contributes to team effort by accomplishing related results as needed.
• Actively supports the achievement of SCAN’s Vision and Goals.

Qualifications

• 1-2 years call center or related customer service experience, required.
• 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans preferred.
• Experience in the healthcare, insurance or pharmacy industry high desirable.
• Ability to maintain calm demeanor at all times, including during highly charged situations.
• Data entry and general computer skills (word processing, e-mail) required.
• Effective communication (oral and written) skills.
• Professional/pleasant telephone manner required.
• Ability to handle large call volume, while providing excellent customer service at all times required.
• Demonstrated efficiency/effectiveness in an environment with a high call volume.

Benefits

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

Pay

Base Pay Range: $20.00-$21.50

Schedule

Work Mode: Remote