Intermediate/Senior Customer Experience Advocate
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Job Description
Customer Experience Advocate delivering service and support for health inquiries in Texas. Collaborating with stakeholders and providing solutions to enhance customer experiences.
Responsibilities:
- Respond to inquiries from members, providers, and brokers, delivering timely, accurate, and high-quality service.
- Phone will be the primary channel of communication, with some use of email and chat as well.
- Manage the end-to-end lifecycle of inquiries, ensuring clear communication, thorough follow-up, and complete resolution.
- Research and resolve issues related to benefits, eligibility, claims status, billing discrepancies, and cost-sharing.
- Interpret plan documents, policies, and internal guidelines to provide clear and accurate guidance.
- Initiate and track claims adjustments, reprocessing, or escalations in accordance with established procedures.
- Identify root causes of issues, address underlying needs, and recommend process improvements.
- Document all interactions in the CRM system (Salesforce) in compliance with HIPAA, privacy, and audit requirements.
- Collaborate with cross-functional teams to validate data, resolve issues, and address systemic challenges.
- Regularly work a schedule of 8:00 a.m. to 5:00 p.m. Central time, Mondays through Fridays.
- Serve as an escalation point for complex or sensitive inquiries, ensuring effective and timely resolution.
- Act as a subject matter expert, providing guidance on complex benefits, claims, and policy scenarios.
- Lead cross-functional coordination to resolve high-impact issues and drive sustainable solutions.
- Mentor and support team members through coaching, training, and knowledge sharing.
- Contribute to quality assurance and continuous improvement efforts, modeling best-in-class service delivery.
Requirements:
- A high school diploma or equivalent required; Associate or Bachelor’s degree preferred.
- Experience working in a fast-paced call center environment, ideally in healthcare customer service.
- You should have at least 2 years of related work experience for the intermediate role and 4 years for the senior role.
- Experience supporting multiple communication channels (phone, chat, email).
- Working knowledge of health insurance terminology, claims processing, benefits, and/or provider services preferred.
- Strong verbal and written communication skills.
- Demonstrated ability to work in a fast-paced, metrics-driven environment.
- Proficiency with computer systems and ability to navigate multiple platforms simultaneously.
- A quiet, dedicated work space, free from distraction to best serve stakeholders.
- It would be great if you are bilingual in English and Spanish.
- Have previous experience in a HIPAA-regulated environment.
Benefits:
- Automatic 4% employer contribution to retirement plan
- 401k plan with 100% match up to 6%
- Flexible time off for vacation, illness, etc.
- Nine paid holidays
- Day one health, Rx, vision, and dental insurance
- Life and disability insurance
- Flexible spending account
- Pet coverage and pet Rx discounts
- Free identity theft protection
- Free 2nd medical opinion service
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