Job Description

We’re hiring people who are dependable to their core and who have the grit and tenacity to show up and work hard even when the going is tough. Our advocates play a key role in building customer loyalty, resolving customer issues the first time and making customer connections that impact the growth and continued success of the largest health insurer in New York State. Simply put, people count on us. Count on us to help them navigate the complicated health care system and provide guidance for themselves and their families. We offer comprehensive training, growth opportunities and great benefits! Start your career and join our team of dedicated professionals passionate about providing exceptional service to our customers.

Summary The Customer Care Advocate (CCA) resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA and legislative requirements. The Customer Care Advocate provides service for customers and business partners while responding in a professional, efficient, and timely manner to resolve issues and enhance member & provider satisfaction/retention. Essential Responsibilities/Accountabilities All Levels: • Provides service among the customers and business partners while responding in a professional, efficient, and timely manner to enhance member and provider satisfaction and retention. Must exercise tact, patience, and professionalism at all times in responding to internal/external customers. • Documents, researches, interprets and responds to inquiries from internal and external customers, business partners and special groups concerning our products, services and policies in accordance with MTM, NCQA, HIPAA, NYSDOH, CMS and other legislative requirements. • By utilizing appropriate resources, resolves customer inquiries accurately & efficiently; resulting in acceptable quality, First Contact Resolution, and performance. • Provides outreach related to claims, onboarding, effectuation, retention, provider inquiries, and any other complex inquiry. • Demonstrates willingness to adapt and be flexible to changes and business needs while taking ownership and accountability for issue identification and resolution. • Ongoing participation in meetings, training, and skill development to support career path and individual development plans. • Is knowledgeable and enthusiastic about the company and our products and/or services. • Identifies and follows through on issues impacting the Health Plan and customer experience. • Develops effective internal working relationships for improved communication and collaboration. • Shares ideas and solutions to improve processes, procedures, and systems • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs. • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. • Regular reliable attendance is expected and required. • Performs other functions as assigned by management. Flex Team Specifics (Starting at Level II): • Advocates can apply for flex team advocate positions if they meet the following expectations: o Advocate must be skilled to Level II or higher. o Advocate must be cross-trained on claims processing adjustments. • Advocate will be expected to flex workload between on-phone work and claims inventory processing as needed. Minimum Qualifications Note of Classification: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Level I: • Associates degree in Business Administration, Health Care Administration, Health Economics or related. In lieu of degree, minimum of 1 year of customer service experience required; preferably in a call center environment. • Entry level position. Duties performed under close supervision. • Attends all training required to become proficient in position. • Ability to multi-task in order to efficiently resolve customer concerns, by actively listening to the customer, navigating screens on the computer, typing call documentation, and speaking to the customer simultaneously. • Excellent computer skills required, including the ability to navigate in a Windows environment. Skillful at working between multiple programs and applications at the same time. • Adept at communicating effectively and diplomatically while working as a collaborative team member. • Organizational, reasoning and problem solving skills. • Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment and remain professional and focused under multiple pressures and demands. • Completed training on at least 1 Line of Business (LOB). Level Il: In addition to Level I requirements: • Performance rating of “Performing” or above for past 12 months. • Proficiency rating of “Intermediate” or above on primary LOB for a minimum of 3 months. • Completed training on 2nd LOB. • Flex Team Specific: Can apply for a flex team position if cross-trained in claims processing. Level III: In addition to Level II requirements: • Performance rating of “Performing” or above for past 12 months. • Proficiency rating of “Intermediate” or above on primary and secondary LOB for a minimum of 3 months. • Completed training on 3rd LOB with 1 LOB being Pharmacy. • Flex Team Specific: Can apply for a flex team position if cross-trained in claims processing. Level lV: In addition to Level III requirements: • Performance rating of “Performing” or above for past 12 months. • Proficiency rating of “Intermediate” or above for a minimum of 3 months on primary, 2nd, and 3rd line of business. • Completed training on 4th LOB. • Flex Team Specific: Can apply for a flex team position if cross-trained in claims processing. • Can support specialized Groups to provide custom benefit quoting. Level V: In addition to Level IV requirements: • Performance rating of “Performing” or above for past 12 months. • Proficiency rating of “Intermediate” or above for a minimum of 3 months on 1st, 2nd, 3rd and 4th LOB. • Flex Team Specific: Can apply for flex team position if cross trained in claims processing. • Provides back up support to assist queue or floor support. • Provides expertise, daily support, mentoring, coaching, and guidance to other advocates • Assists in the research and resolution to member and provider grievances • Offers in person support at business and partner locations as needed Physical Requirements • Work is completed in a traditional office environment under fluorescent lighting. • Ability to arrive on time at work and as scheduled. • Ability to use a headset to listen to customer conversations required. • Ability to meet minimum performance metrics. • Ability to orally communicate. • Must be able to function while sitting at a desk viewing a computer and using a keyboard and mouse for 3 or more hours at a time. • In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve. Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce. OUR COMPANY CULTURE: Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer

Company Description

Excellus BlueCross BlueShield, headquartered in Rochester, NY, is part of a $6 billion family of companies that finances and delivers health care services across upstate New York and long term care insurance nationwide. Collectively, the enterprise provides health insurance to nearly 1.5 million members and employs about 5,000 New Yorkers. The company has financial strength rating of "BBB+" (Stable) by Standard and Poor's. Previously, the company's BlueCross BlueShield operations were known as: BlueCross BlueShield of Central New York, BlueCross BlueShield of the Rochester Area, and BlueCross BlueShield of Utica-Watertown. Today, Excellus BlueCross BlueShield maintains a strong local presence through four regional headquarters and additional field offices: Central New York Region, based in Syracuse with an additional office in Watertown; Central New York Southern Tier Region, based in Elmira with an additional office in Binghamton; Rochester Region, based in Rochester; and Utica Region, based in Utica with an additional office in Plattsburgh. Mission To help people in our communities live healthier and more secure lives through access to high quality, affordable health care. Vision To be recognized and valued as THE community and business resource for health care security through financial strength, effective cost control, ease of use, and commitment to health improvement.