Participant Advocate - Customer Service
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, 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
- 1+ year of customer service experience
- Must type a minimum of 40 wpm
- High School Diploma required
- Demonstrate initiative and the drive to serve others, learn, and succeed
- Excellent written & verbal communication skills
- Proficiency in MS Office is required