Customer Service Advocate
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Job Description
Customer Service Advocate supporting Blue Cross NC members, employers, and providers. Resolving benefits and claims issues while guiding healthcare decisions and digital self-service.
Responsibilities:
- Act as a service expert for Blue Cross NC customers, employer groups, and providers
- Develop, manage, and expand customer relationships while meeting service expectations
- Respond accurately, promptly, and professionally to members, employer groups, providers, and other stakeholders across phone and chat channels
- Resolve customer concerns and educate customers about benefits, claims, and eligibility
- Conduct training sessions at employer sites and facilitate online sessions
- Support complex inquiries involving serious health conditions and complex claims or benefit issues
- Screen members to determine case management needs and use administrative or clinical resources as needed
- Adjust simple/routine claims for providers
- Provide multi-omni-channel inbound and outbound inquiry support
- Diagnose and resolve issues using probing and creative problem-solving techniques
- Help customers navigate online and mobile tools and encourage self-service
- Educate customers on benefit plan selections, health plan value, and quality care providers
- Drive new ideas, innovation, and continuous process improvement
- Engage with local, state, and federal government entities and plan participants regarding products, services, and policies
- Serve as a subject matter expert or mentor for non-routine inquiries
- Query, analyze, and interpret data to address customer and business needs
Requirements:
- High school diploma or GED
- 3+ years of experience in related field
- Proven, hands-on Facets experience (bonus point)
- Strong customer/member service orientation
- Knowledge of benefits and eligibility
- Strong claims knowledge, including the ability to review a claim and connect the claim to applicable benefits
- IPP experience is preferred but not required
- Active Listening
- Client Issue Resolution
- Customer Care
- Customer Education
- Customer Engagement
- Customer Satisfaction
- Customer Service
- Customer Service Operations
- Key Customer Management
- People Management
Benefits:
- Annual Incentive Bonus based on annual corporate goal achievement and individual performance
- 401(k) with employer match
- Paid Time Off (PTO)
- Competitive health benefits
- Wellness programs
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