Customer Care Advocate IA

Customer Care Advocate IA

Blue Cross and Blue Shield Association | Rochester, NY, 14618, US
Salary Range:$37,000 – $48,000 Salary range estimated by Zippia

Posted 9 days ago

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The Customer Care (CC) Advocate resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA, and legislative requirements. The Customer Care Advocate 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. The B version of this role requires the individual to speak Spanish fluently.

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.
* 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 MTM, NCQA, HIPAA, NYSDOH, CMS and other legislative requirements.
* By utilizing appropriate resources, resolves customer inquiries accurately & efficiently resulting in acceptable quality, First Contact Resolution, and performance.
* 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 identification and resolution.
* Ongoing participation in meetings, training, and skill development to support career path and individual development plans.
* Is knowledgeable and enthusiastic about the company and our products and/or services.
* Identifies and follows through on issues impacting the Health Plan and 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.

Minimum Qualifications

NOTE: 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:

* High School diploma or equivalent, customer service experience preferred.
* Entry level position. Duties performed under close supervision.
* Attends all training required to become proficient in position.
* B Version: Bi-lingual English/Spanish required (must have ability to speak Spanish fluently).
* 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 at least one part of Scheduling unit.

Level Il - in addition to Level I requirements:

* Rating of "Performing" or above on the Agent Dashboard and Competencies for a minimum of 9 out of 12 months.
* Completed training on all parts of scheduling unit.
* Ability to efficiently resolve complex & escalated issues with minimal direction.
* Advanced system and navigational skills.
* Expanded communication skills across multiple channels including, but not limited to, voicemail, email, web chat, outbound calls, membership growth, retention, etc.
* Takes accountability and ownership of issues and resolution with minimal supervision.
* Dental & Medical Intake Units Specific:

o Rating of "Performing" or above on the Agent Dashboard and Competencies for a minimum of 9 out of 12 months.

o -OR- Move to & complete training for Commercial Unit.

Level III - in addition to Level II requirements:

* Rating of "Performing" or above on the Agent Dashboard and Competencies for a minimum 10 out of 12 additional months.
* Self-sufficient in resolving complex & escalated issues.
* Provide mentoring and support to new hires and peer group.
* Assist with tasks assigned by management that require advanced problem-solving skills.
* Demonstrates global thinking and takes initiative to recognize opportunities within the team
* Dental & Medical Intake Units Specific:

o There is no level III option for these two units. Must move to Commercial unit to continue level progression.

* Commercial Unit Specific:

o Rating of "Performing" or above on the Agent Dashboard and Competencies for a minimum of 10 out of 12 months.

o -OR- Move to & complete training for Dedicated Unit.

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 meet minimum performance metrics.
* 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.
* Regularly required to talk.
* Regularly required to hear.

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.


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