The Universal Service Advocate IV in Florida Blue Medicare is a key role within the organization that will serve potential, new and existing customers which include individual O65 members, group members, business decision makers and agents. This role will work across many systems and multiple business areas to resolve inbound service inquiries, process enrollment and billing transactions, and relay claims and benefit details to O65 beneficiaries. Service Advocates resolve questions and issues to help customers utilize products, tools, services, and directly contribute to customer satisfaction and retention across all systems.
Essential Job Functions
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Review a member’s enrollment or claims history including all debits and credits and claims detail level at the member level for a multi-year period ensuring accuracy of billing and enrollment and application of deductible and member responsibility.
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Answer inbound calls related to Billing, Enrollment, Claims, and Benefits
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Resolve complex inquiries including escalations and acting as a Subject Matter Expert for Medicare Operations.
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Utilize the Florida Blue Call Strategy to provide outstanding customer service and call resolution to our members; follow-up on issues to ensure resolution for customer.
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Evaluate data through questioning, probing, and reasoning for process improvements.
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Research and resolve service related inquiries for all lines of business, health and ancillary products, meeting established expectations for quality, productivity and timeliness. This position will handle calls received from Federal Regulated Entities (e.g. CMS, Social Security)
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Willingness to cross-train in multiple functions (i.e. Claims, EMB, Contact, & Escalations)
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Ability to differentiate between Customer Obsession and General Customer Service
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Participate in a 8-10 weeks training learning of claims benefits and enrollment systems (e.g. Sapphire, Customer Connect, Waypoint, MarX, HPMS, Siebel, and Diamond
Minimum Job Requirements
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2 years customer service experience including; (retail, face to face, phone, chat, experience with financial reconciliation and accounting activities and/or claims processing)
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1 year of collaboration relationship building with external partners, such as sales agents, brokers, consultants, key accounts, providers and vendors
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Ability to resolve/respond to customer inquiries and concerns, using sound problem solving and decision making skills
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Demonstrated empathy and compassion, with outstanding listening and communication skills
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Ability to work assigned shift and or nights, weekends, holidays as business needs requires, in a production environment answering questions and resolving simple to complex issues
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Ability to support other work functions within the department to meet organizational objectives and goals
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Excellent Written and Verbal Communication
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Willing to work a flexible schedule and participate in a shift bid
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High school diploma or equivalent