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Independent Health Advocate-Servicing Medicare in Williamsville, New York

FIND YOUR FUTURE

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

Overview

The Advocate–Servicing shall be accountable to provide coaching to servicing team members by assisting with questions regarding appropriate handling of member calls and/or correspondence. The Advocate- Servicing is responsible for providing support and expertise to the customer service representatives and the overall department by handling, documenting, and resolving escalated calls and issues. Additionally, the individual provides support to the department and representatives to appropriately respond to correspondence, e-mail, administrative transactions and web inquiries submitted by customers with respect to grievances/complaints, appeals, and organization/coverage determinations. The Advocate–Servicing will work closely with the servicing leadership team and staff to identify opportunities to educate customers and ensure first call resolution as well as make recommendations for process improvements. The Advocate shall provide backup floor support for the Servicing Supervisors as needed. The Servicing, Advocate will require comprehensive knowledge of products, riders, events, systems, etc. to effectively meet both departmental and regulatory guidelines and targets.

Qualifications

  • High School diploma or GED required. Associates degree preferred.

  • Three (3) years of operations/customer service, related experience required with demonstrated and proven experience resolving complex issues for members/team members with minimal assistance from supervision required.

  • Demonstrated ability to effectively communicate with internal and external customers both in writing and on the phone including resolving customer complaints in writing.

  • Demonstrated ability to act as an advocate and work with other departments, at all levels of the organization, in a collaborative manner to resolve escalations.

  • Demonstrated proficiency in problem solving and proven ability to multitask and prioritize accordingly.

  • Strong working knowledge of benefit structures of all Independent Health plans.

  • Thorough knowledge and experience with Independent Health systems as required.

  • Strong organizational/time management skills.

  • Ability to assume responsibility and maintain confidentiality. Strong sense of accountability is required. Must be able to work collaboratively. Flexibility to work additional hours and shift assignment as required by department.

  • Excellent written and verbal communication skills with demonstrated and proven ability to provide exceptional customer service to external and internal customers.

  • Understands the importance of maintaining the physical and technical security and privacy of protected health information (PHI).

  • Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Essential Accountabilities

Customer Service Representative Support:

  • Provide coaching to Customer Service Representatives on interactions when Representative is unable to locate an answer.

  • Provide feedback to Servicing and Training leadership teams on identified gaps in processes. This will be done through documentation, tracking, and analyzing interactions with representatives and suggesting process improvements.

  • Work collaboratively with cross functional teams to gain consensus and make decisions

  • Demonstrate strong working knowledge of benefit structure of all Independent Health plans.

  • Ensure decisions are made within agreed upon timeframes.

  • Escalate issues as needed to supervisor.

T echnical Proficiency:

  • Maintain technical knowledge regarding Independent Health’s contracts and benefits and working knowledge of policies and procedures and updates daily.

  • Attend required training sessions as needed.

  • Provide accurate and up-to-date information to all customers by documenting all pertinent information into appropriate systems to meet regulatory agency standards (NCQA, State, CMS etc.), addressing first level complaints and assisting appeals as needed.

  • Demonstrate knowledge of all systems (Siebel, HealthRules, RX Claims, MACESS, Focus, E-mail) and other systems as needed and the ability to coordinate the use of these tools at the same time.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here (https://www.independenthealth.com/AboutIndependentHealth/Careers/AdditionalEEO-AAPInformation) for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.

Independent Health, a not-for-profit health plan headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio of progressive products include HMO, POS and EPO products, Medicare and Medicaid plans, traditional indemnity insurance, individual and small group Exchange products, consumer-directed plans and health savings accounts, plus coverage for self-funded employers.

Independent Health has augmented its highly successful insured product portfolio with services employers and employees need to better manage their health care expenses through its affiliate companies, including the Independent Health Foundation, Pharmacy Benefit Dimensions, Reliance Rx and Nova Healthcare Administrators.

Our award-winning customer service, dedication to quality health care and unmatched relationships with physicians and providers has allowed us to be consistently recognized as one of the highest-ranked health insurance plans in the nation.

We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact the Manager, Talent Acquisition in Human Resources at:

Talent@independenthealth.com or (716) 635-4800

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