Broker Concierge Sales and Service Associate II

Job Summary:

The Broker Concierge Sales and Service Associate II primarily serves as a dedicated operational advocate for Care Source's highest performing brokers, agencies and FMOs. Provides high-touch, personalized support by owning complex pre and post enrollment issues including member onboarding concerns, provider and network inquiries, benefit and eligibility questions, billing issues and general service escalations through final resolution.

Essential Functions:

Responsible for researching and resolving issues spanning the pre and post enrollment process for Broker enrollees with a focus on first call resolution or ongoing case management through resolution.

Collaborates with the various departments virtually, to resolve member related issues and broker escalations, to provide a comprehensive resolution.

Exercises independence to complete Broker related research, fulfillment, and inquiry requests efficiently and timely.

Accesses and extracts data from a variety of primary and secondary sources and in a variety of formats as part of the resolution process.

Conducts thorough research of ancillary vendors third party systems, health plan sites, portals, internal reference material, and custom tools to identify accuracy of information and identify root causes of issues.

Responsible for timely and effective processing of any aging inventory of broker/member requests, to full resolution.

Works closely with other business owners to identify root causes of issues and resolve barriers experienced by members.

Accesses and understands all related benefit coverage resources, tools, and materials to respond to a member’s inquiries and concerns correctly.

Thoroughly logs all broker interactions into appropriate databases for purposes of accurate tracking and analysis.

Troubleshoots escalated member related issues reported by brokers.

Performs follow up calls to members and brokers for dental, pharmacy, and other benefit inquiries that were not a one call resolution, including processing pharmacy overrides and rejections for members/brokers.

Adhere to all departmental and company policies and procedures.

Assist prospective members with selecting and enrolling in the Care Source exchange health plan by educating members on our benefits and services, educating members on plan premiums, co-pays and coinsurance, answering all Healthcare Exchange inquiries, and assisting with the application process for enrollment.

Serve as a subject matter expert on Care Source exchange healthcare plans and product lines.

Perform any other job related duties as requested.

Education and Experience:

High School or GED required

Associates degree preferred

Three (3) years of customer service, sales support or other related experience required

Commercial insurance sales experience preferred

Competencies, Knowledge and

Skills:

Computer proficiency with knowledge and experience in a Windows environment

Typing speed of 35 words per minute (WPM)
Maintain regulatory knowledge for compliance to ODI, CMS, and Care Source requirements

Strong written and verbal communication skills

Professional phone etiquette

Proper use of grammar

Ability to work in a fast paced environment

Adaptable to a constantly changing environment

Customer service experience

Solid self-management and time management skills

Ability to work effectively independently and within a team environment

Critical thinking and listening skills

Decision making and problem solving skills

Demonstrates confidence and positivity

Sales skills to meet enrollment objectives

Professional telemarketing skills

Licensure and Certification:

Current, unrestricted State Insurance license in Accident and Health in state of practice within state(s) of assigned territory may be required or ability to achieve license(s) within 30 days of hire preferred

If a Federally-Facilitated Marketplace (FMM) State, certification from the Health Insurance Marketplace and annual recertification each year thereafter preferred

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Will work in a phone queue;
Required to use general office equipment, such as a telephone, photocopier, fax machine, computer

Travel is not typically required

Compensation Range:$41,200.00 - $66,000.00

Care Source takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when…