Member Service Advocate
Long Beach, CA
Our mission is simple: Keeping Seniors Healthy and Independent that s been our mission for almost 40 years. Rated as one of the top Medicare Advantage plans in California, SCAN Health Plan employees are passionate about what they do. Understanding that success is based on achieving the mission, SCAN employees are afforded with the training and tools necessary to do their jobs and they are rewarded for their efforts and recognized as experts in their fields. Ask anyone who works here and we ll proudly tell you that SCAN s commitment has never wavered. We are as steadfast in our pledge to help our members live healthy and independent lives.
Serve members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services. Ensure member satisfaction by providing superior customer service and a willingness to help at all times while maintaining a professional demeanor.
Provide quality customer service by applying SCAN Five Service Principles. Educate members, family, friends, providers and caregivers regarding benefits and plan options.
Accurately explains benefits and plan options in person, via email or telephonically.
Provide follow-up with members by clarifying the customer s issue, determining the cause, and identifying and explaining the solution. Escalate appropriate member issues to management or other departments as required.
Consistently meet and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance.
Respond appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids. Take ownership of the issue, focusing on providing solutions and options for member, as necessary through resolution of member issue.
Increase member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed.
Participate in member calling projects as assigned by management to support the overall SCAN goal of membership retention.
Follow policies and procedures and job aids in order to maintain efficient and compliant operations; communicates suggestions for improvement and efficiencies to management; identify and report problems with workflows following proper departmental procedures; actively participate in departmental staff meetings and training sessions.
Follow all appropriate Federal and State regulatory requirements and guidelines applicable to SCAN Health Plan operations, as documented in company policies and procedures. Follow all HIPAA requirements.
Document transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
Contribute to team effort by accomplishing related results as needed.
Actively supports the achievement of SCAN s Vision and Goals
High School diploma or equivalent.
1 - 2 years of call center or related customer service experience.
Ability to maintain calm demeanor at all times, including during highly charged situations.
Data entry and general computer skills (word processing, e-mail).
Effective communication (oral and written) skills. Professional/pleasant telephone manner.
Ability to handle large call volume, while providing excellent customer service at all times.
Demonstrated efficiency/effectiveness in an environment with a high call volume.
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!