Customer Service Advocate II (In-Office)

**Resp \& Qualifications** **PURPOSE:** Responsible for answering member, provider \& broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. Proactively provides information and education to members, providers \& brokers, as appropriate, about a variety of health, financial, and self\-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications. **ESSENTIAL FUNCTIONS:** * Provides first\- level problem resolution to member, provider and broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures. * Uses knowledge of products or services by collecting and the contractual provisions that govern administration to provide customer information service and analyzing education, to interpret contractual language to the customer needs for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. Appropriately documents all client interactions according to established departmental procedures. * Prioritize workflow \& multitask efficiently in a fast pace environment while using multiple skill sets with demonstrated proficiency. * Delivers accurate information to customers in accordance with performance goals and objectives. * Maintains customer advocate records by identifying underlying customer needs and guiding them to appropriate resources or programs updating account information by effectively utilizing the business areas enrollment/inquiry tracking system \& processe