Membership Service Advocate OTC

Helpware is a technology-driven company with offices in the USA, Ukraine, Mexico, and the Philippines which provides Customer Experience & Operational Support for modern companies. Our team of professionals is driven by the purpose of providing best-in-class value-adding services to our partners by leveraging our empowered teams, innovative solutions, and technologies. Position Summary: As a Member Services Advocate, you will be a part of a team that transforms customer service into Customer Care by delivering an amazing experience. You will assist beneficiaries with a wide range of critical services, which include but not limited to updating account information, providing plan information, resolving issues with utilization of the plan. Qualified candidates will have a strong desire to help people with strong customer care skills, attention to detail, and highly organized.

Responsibilities

Update account information such as billing options and changes of address or phone numbers; Research premium billing discrepancies and prescription claims processed; Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage; Submit mail requests for beneficiaries such as ID cards and formularies; Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why; Displays positive demeanor, technical accuracy, and conformity to company policies; Understands CMS guidance and ensures applicable Exhibits are being mailed per CMS guidance; Ensure HIPAA regulations are maintained within the immediate environment; Responsible for concise and detailed notations as it pertains to member records; Handles outbound calls for purposes of validating information; Handles inbound calls by assisting members with a high level of accuracy and efficiency; Escalates any member issues to management as necessary; Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner; Conform with and abide by all regulations, policies, work procedures and instructions; Respond promptly when returning telephone calls and replying to correspondence and faxes; Act, dress, and behave in a professional manner to reflect a positive image of the company

Requirements

Associate Degree preferably in Healthcare; Minimum 3 years working in a fast paced high volume call center environment, retail customer service, preferably in healthcare or hospitality; Ability to multi-task effectively with strong attention to detail when documenting customers reasons for calling; Excellent written communication skills; Excellent problem-solving abilities - Must love customer service with excellent listening skills, demonstrate empathy and the ability to educate customers; Ability to de-escalate matters in a calm and professional manner; Comfortable with technology and navigating numerous systems simultaneously; Unwavering dedication to serving a customer that has complex needs; Requires strong technical skills with Microsoft Office (Excel, word, and Outlook); Must have an energetic phone presence - professional etiquette over the phone, through written and face to face communication; Self-motivated, confident, reliable and commitment to customer satisfaction; Adherence to following internal policy; Ability to interact professionally and maintain effective working relationships with superiors, coworkers, customers, and others; Ability to break down complicated information into simple messages for the caller