Customer Service Advocate III - Medicare (Remote)

**Resp \& Qualifications** **PURPOSE:** Responsible for answering member, provider \& broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers \& brokers, as appropriate, about a variety of health, financial, and self\-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications. Maintains a more advanced knowledge of company products and services. Mentor and lead lower level Customer Service Advocates. **ESSENTIAL FUNCTIONS:** * Uses knowledge of products or services by collecting and the contractual provisions that govern administration to provide customer information service and analyzing education to interpret contractual language to the customer needs for the purpose of providing benefit utilization and limitations to determine the need for managed care initiatives and to administer all types of service to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments if applicable. Appropriately documents all client interactions according to established departmental procedures. * Resolves highly complex member, provider and broker inquires by gathering and investigating information; verifying customer understanding of information and resolves issues based on applicable policies and procedures; examine claim submissions verifying claim and system accuracy as well as liability. Prioritize workflow and multitask efficiently in a fast pace environment while using multiple skill sets with demonstrated high proficiency. * Acts as the lead Customer Service Advocates to ensure that the team provides accurate and consistent information to inquiries in a courteous, timely, and professional manner. Mentors and coaches team on policies changes, system updates, learning tools, or other job requirements to provide a consistent base for new employees. * Maintains a positive and enthusiastic attitude in an environment that requires teamwork, efficiency, cross\-training, and continuous improvement. * Ensures compliance with Standard Operating Procedures and serves as a resource to the staff. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources. **QUALIFICATIONS:** **Education Level:** High School Diploma or GED. **Experience:** 5 years customer service experience. **Preferred Qualifications**: 5 or more years experience in a call center customer service role or experience with medical or insurance terminology * **Knowledge, Skills and Abilities (KSAs)** * Demonstrated skills as an empathetic and compassionate communicator. * Ability to quickly gain customer trust and confidence. * Demonstrated PC naviga