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FEP Customer Care Advocate I/II/III- 11391 at Excellus Health Plan Inc.

Posted in General Business 30+ days ago.

Type: Full-Time
Location: Utica, New York





Job Description:

Summary
The Federal Employee Program (FEP) Customer Care Advocate works to resolves customer inquiries via telephone, walk in, mail, fax, eService, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with FEP PIP Scorecard, NCQA and Federal requirements. The position provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention.

Essential Responsibilities/Accountabilities
All Levels:
• Provides service among the customers and business partners while responding in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention. Must exercise tact, patience, and professionalism at all times in responding to internal/external customers inquiries.
• Documents, researches, interprets and responds to inquiries from internal and external customers, business partners and special groups concerning our products, services and policies in accordance with FEP, NCQA, HIPAA, NYSDOH, CMS, other legislative and Federal requirements.
• By utilizing appropriate resources, resolves customer inquiries accurately & efficiently; resulting in acceptable quality, First Contact Resolution, and performance standards.
• Provides outreach related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry.
• Demonstrates willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue root cause, identification and resolution.
• Ongoing participation in meetings, training, and skill development to support career path and individual development plans.
• Have continued knowledgeable of and enthusiasm about the company and our products and/or services.
• Identifies and follows through on issues impacting the Health Plan and subsequent customer experience.
• Develops effective internal working relationships for improved communication and collaboration.
• Shares ideas and solutions to improve processes, procedures, and systems.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular reliable attendance is expected and required.
• Performs other functions as assigned by management.
• Works in liaison with FEPDO (Federal Employee Program Directors Office) on issues identified
• Use of FEP Member 360.

Minimum Qualifications
Note of Classification: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

Level I:
• Associates degree in Business Administration, Health Care Administration, Health Economics or related. In lieu of degree, minimum of 1 year of customer service experience required; preferably in a call center environment.
• Attends all training required to be proficient and stay updated with relevant information relative to the position.
• Ability to multi-task in order to efficiently resolve customer concerns, by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously.
• Excellent computer skills required, including the ability to navigate in a Windows environment. Skillful at working between multiple programs and applications at the same time.
• Adept at communicating effectively and diplomatically while working as a collaborative team member.
• Organizational, reasoning and problem-solving skills.
• Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands.
• Completed training on FEP Line of Business.
Level Il: In addition to Level I requirements:
• Performance rating of "Performing" or above for past 12 months.
• Proficiency rating of "Intermediate" or above on FEP Line of Business of 3 months.
• Completed training on written correspondence and FEP eService requests.

Level III: In addition to Level II requirements:
• Performance rating of "Performing" or above for past 12 months.
• Proficiency rating of "Intermediate" or above on all FEP workstreams with high quality. Provides back up support to assist queue or floor support.
• Provides expertise, daily support, mentoring, coaching, and guidance to other advocates
• Assists in the research and resolution to member and provider grievances

Physical Requirements
• Work is completed in a traditional office environment under fluorescent lighting.
• Ability to arrive on time at work and as scheduled.
• Ability to use a headset to listen to customer conversations required.
• Ability to meet minimum performance metrics.
• Ability to orally communicate.
• Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time.
• Must be able to travel across the enterprise. Will need to work at a PC for extended periods of time.

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer





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