POSITION DESCRIPTION

POSITION: Participant Advocate - Customer Service

JOB CLASSIFICATION: Non-Exempt

REPORTS TO: Customer Service Supervisor

JOB SUMMARY – The Participant Advocate will support, promote, and consistently deliver a premier participant experience at all times. During each communication, sincere, empathetic, accurate, and efficient service will be provided. All phone calls, email, and written correspondence with participants, key local union and single employer contacts, providers, vendors, and other participant advocates will be conducted with the utmost of courtesy and professionalism.

PRINCIPAL DUTIES AND RESPONSIBILITIES

To obtain, accurately interpret, and maintain a thorough working knowledge of all FMCP Summary Plan Description provisions including multiple benefit schedules, as well as a clear understanding of the eligibility system, claim payment system, and the Reciprocity system (ERTS)
Support, promote, and consistently deliver a premier participant experience
Respond timely and accurately to phone calls, e-mail, walk in participants, and correspondence by answering questions; explaining claim payments and reason for any claim denials; quote self-payment amounts; verify eligibility and/or benefits; research eligibility or claim issues; update eligibility with outside vendors
Demonstrate honesty, integrity, compassion, and empathy in all interactions
Escalate all participant-related concerns to the appropriate individual(s) for timely and accurate resolution
Document all phone calls accurately and timely in the Customer Service module
Perform various clerical duties (i.e., enter enrollment forms; process working spouse forms, process special fund claims; process disability claims, etc.).
Navigate and provide accurate information regarding FMCP website
Monitor incoming calls and calls waiting via call management system
Pick up and handle messages from nightline
Work on special projects as requested by Management
Other duties as assigned

REQUIRED AND PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES

1+ year of customer service experience
Must type a minimum of 40 wpm
High School Diploma required
Demonstrate initiative and the drive to serve others, learn, and succeed
Excellent written & verbal communication skills
Proficiency in MS Office is required
Dependability – ensures timely arrival and consistent attendance in support of FMCP participants and the achievement of team goals.
Demonstrates the ability to manage all issues while maintaining a flexible, positive, caring, and cooperative demeanor
Responds in a timely manner to operations leaders and stakeholders to facilitate informed decision-making
Troubleshoots assigned issues, gathers evidence, and investigates all relevant information with participants, vendors, and internal departments to resolve the problem in a cooperative and collaborative manner

WORK SCHEDULE

In-office -
40 hours, Monday through Friday, with daily 1 hour unpaid lunch

Job Type: Full-time

Pay: $20.00 - $30.00 per hour

Benefits:

401(k)
Dental insurance
Flexible spending account
Health insurance
Life insurance
Paid time off
Retirement plan
Vision insurance

Application Question(s):

Are you able to work the scheduled hours of 10 am - 7 pm?

Experience:

medical insurance call center: 1 year (Required)
Inbound call center: 1 year (Preferred)

Work Location: In person

Family Medical Care Plan (FMCP)

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