AdvocateMe CSR - Indiana

Applicants must be located in the State of Indiana to be considered for this position

Positions in this function provide expertise and customer service support to members of our client at United Health for the Advocate4

Me model. Responsibilities include direct phone-based customer interaction to address complex member needs and provide recommendations on services that may help close gaps in care for the member and/or the member’s family. Representatives also authorize claims payments or refer claims to investigators for further review.

This position is full-time (40 hours/week) Monday-Sunday. Employees are required to have flexibility to work any of our eight-hour shift schedules during our normal business hours of 8:00am- 8:00pm EST with holidays, weekends, and overtime as business needs require. Training will be conducted virtually from your home. Employees are required to live in the State of Indiana. Travel is required to the Indianapolis location at least one day a month and may be required to additionally travel to the Indianapolis office upon request by supervisor or manager as job duties demand.

In our concierge service structure, Representatives’ primary day-to-day function is navigating inbound calls from members, including end-to-end issue identification and resolution.

This role will work one-on-one with assigned eligible members and their caregivers focusing primarily on identification and support of member needs by providing recommendations that help care for the member and/or assist the member’s family. Daily responsibilities include engaging with members through inbound calls, assisting in providing resolution of member issues, and driving positive health outcomes.

• are best
  -in-class dedicated customer service agents, providing concierge and white-glove level service; removing burdens; and providing end-to-end resolution for customers;
• manage members issues to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member;
• communicate with members and their care givers regarding anticipated member service needs and resolution of issues;
• research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs;
• may be asked to work independently after hours to resolve urgent issues that surface after normal business hours;
  This role has the ability to work outside of established procedures to ensure high-level member satisfaction;
• identify gaps in processes and work closely with other departments for process improvement;
• provide education and status on previously submitted pre-authorizations or pre-determination requests, as appropriate;
• ability to handle high-pressure situations;
• apply conflict management skills, including the ability to remain calm and composed while de-escalating conflict;
• dynamic work environment with demanding expectations

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Employees will train to gain proficiency in member tools, benefit interpretation, and complex issue management to interpret situations and proactively address complex member issues.

• focus on managing Inbound calls, with only…