Member Advocate - Bilingual

Gold Kidney Health Plan

Full-time

Overview

Job Type : Full-time

Description

GOLD KIDNEY CORE VALUES:

Gold Kidney Health Plan is a people business. Our success depends on having the best and brightest employees and helping them attain their personal and professional goals while delivering excellence in patient care and business results. Our employees embody our culture, which is based on six core values supporting our promise to improve the quality of life of every patient every day. These core values are Patients and Partners First, Honesty and Integrity, Quality and Compliance, Collaboration, No-Limits Mindset and Results Orientation.

PURPOSE AND SCOPE:

Taking inbound calls and making outbound calls where appropriate to resolve member and provider inquiries (our customers) in a timely and accurately in accordance with the company’s mission and vision. Responses and inquiries channels are telephone, email, web/chat and written correspondence. Must be willing and able to work with all channels.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Respond to telephone, email, web/chat, or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources

Provide assistance to members and/or providers regarding website registration and navigation

Document all activities for quality and metrics reporting in the call tracking system

Perform outbound and follow up phone calls to fully resolve member and provider inquires.

Process written customer correspondence and provide the appropriate level of timely follow up

May coordinate member transportation and make referrals to other departments as appropriate (warm transfer process to be adhered to)

Maintain performance and quality standards based on established call center metrics including turn-around times

Build strong, standing relationships with customers for an exceptional experience

PHYSICAL DEMANDS ANDWORKING CONDITIONS:

Work is generally performed in an office or home office environment (management discretion)

Must have the ability to sit for long periods.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

Schedule varies based on month of the year. 8 hour shifts (early/late) are based on Operational Hours and days which align with CMS regulations. Examples are below.

o October-March shift day examples

§ Tuesday – Saturday

§ Sunday – Thursday

§ Monday – Friday

o April-September days are Monday – Friday only

SUPERVISION:

No supervisory responsibilities

EDUCATION:

HS Diploma or equivalent combination of education and experience

EXPERIENCE AND REQUIRED SKILLS:

Six months experience as a Customer Service Representative or previous Call Center, Healthcare or insurance experience

Should be proficient in understanding the working of a call center environment - Skilled in customer service, verbal communication over the phone (ability to multi-task and utilize multiple resources while taking calls)

Microsoft Office, PowerPoint, Word experience and proficiency

Medicare or Medicare Advantage customer service experience preferred

Claims processing, billing and/or coding experience preferred

Proficient in English and SpanishGOLD KIDNEY CORE VALUES

PURPOSE AND SCOPE:

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Respond to telephone, email, web/chat, or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources.
Provide assistance to members and/or providers regarding website registration and navigation.
Document all activities for quality and metrics reporting in the call tracking system.
Perform outbound and follow up phone calls to fully resolve member and provider inquires.
Process written customer correspondence and provide the appropriate level of timely follow up.
May coordinate member transportation and make referrals to other departments as appropriate (warm transfer process to be adhered to)
Maintain performance and quality standards based on established call center metrics including turn-around times.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

Work is generally performed in an office or home office environment (management discretion).
Must have the ability to sit for long periods.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
Schedule varies based on month of the year. 8-hour shifts (early/late) are based on Operational Hours and days which align with CMS regulations. Examples are below.

October-March shift day examplesTuesday – SaturdaySunday – ThursdayMonday – FridayApril-September days are Monday – Friday only.SUPERVISION:

This position does not have supervisory responsibilities.

EDUCATION:

HS Diploma or equivalent combination of education and experience

EXPERIENCE AND REQUIRED SKILLS:

Six months experience as a Customer Service Representative or previous Call Center, Healthcare or insurance experience
Should be proficient in understanding the working of a call center environment – Skilled in customer service, verbal communication over the phone (ability to multi-task and utilize multiple resources while taking calls)
Microsoft Office, PowerPoint, Word experience and proficiency
Medicare or Medicare Advantage customer service experience preferred.
Claims processing, billing and/or coding experience preferred.

Job Type: Full-time

Pay: $18.50 - $24.00 per hour

Benefits: