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Member Care Escalations Advisor

NationsBenefits

Member Care Escalations Advisor

Costa Mesa, CA
Full Time
Paid
  • Responsibilities

    Grow and lead among an award-winning and extraordinary organization that's dedicated to providing premier service and delighting members, 24/7/365. It all begins with how we care about the people we serve. Since 2015, our mission has guided our principles towards delivering solutions for a rapidly changing industry. Compassionate Care is at the center of all we do, and it unites us to foster an environment where everyone is empowered, inspired, and equipped for success.

    We make a difference in the lives of millions; that's something we can be proud of.

    Compensation for all positions is competitively higher than the current marketplace. Simply put - we pay more. We also offer a competitive benefits program, designed to support employees and their families across all dimensions of health including medical, dental, vision, life, disability, 401(k) and paid holidays/time off for eligible employees. You can earn even more through referral bonuses. Achieve your potential and grow your career at NationsBenefits.com/Careers.

    OVERVIEW:

    Our member care escalation advisors (MCEA) are customer service experts who effectively resolve and address problems or transfer issues to a higher-ranking representative for further support. An ideal MCEA will understand the member's needs along with having a passion in making a positive difference for others. If you're the type of person who likes helping your elderly relatives or neighbors deal with their issues, this job will be a good fit.  As an MCEA you will also be responsible for managing escalations relating to NationsBenefits products and services, handling problem tickets, and providing feedback to upper management regarding customer issues.

    KEY RESPONSIBILITIES:

    •  Handles escalations from the direct health plan/ MEA
    •  Handles IT tickets escalated from agents/supervisors (Ticketing System)
    •  Has access to FIS (internal card system) as an additional resource to verify and render more information
    • Ability to remain confidential with all proprietary and private information and adhere to NationsBenefits, HIPAA, and MCO / Medicare guidelines
    • Keeping a clean, organized work area.
    •  Handles Outreaches to members to further probe to render a resolution
    • Live Chat Support for agents, supervisors, and team leads
    • Live email support for agents, supervisors and team leads
    • Keep track of member's issues via Excel spreadsheet
    • Conducts outreaches to members once we have come to a resolution
    • Educates MEAs, Supervisors, and Floor Support in rendering information
    • Identify common issues across different plans
    • Perform tasks and duties with demonstrated timeliness and expertise
    • transfer issues to a higher-ranking representative for further support
    • Direct contact with different departments for issues escalated to our department
    • Create IT related tickets
    • WEB Leads (Callbacks, voicemails, sourced members issues)

    SKILLS FOR ESCALATIONS SUCCESS:

    • Have a structured and organized way of going about daily tasks; attention to detail is a must.
    • Ability to work in a fast-paced environment.
    • Technical savviness to navigate through computer systems and applications.
    • Ability to multi-task and use different tools and resources to identify custom solutions.
    • Skilled at reading and interpreting transactions.
    • Strong mathematical skills.
    • Strong communication skills, both written and verbal, with the ability to adapt communication styles to different customers and situations.
    • Ability to address general and customer-specific inquiries and concerns, as well as being able to explain and guide them through different procedures.
    • Ability to provide clear and concise information, such as explaining clearly and professionally the reasons for declined transactions.
    • Ability to be an analytical thinker, problem solver, and quality oriented.
    • Problem-solving attitude; natural curiosity in finding and understanding the origin of a problem.
    • Mindset of continuous improvement in understanding and addressing customer needs.
    • Integrity and honesty to manage sensitive member information and adhere to all Regulatory and Compliance guidelines related to healthcare and banking practices.
    • Advanced typing skills (45 WPM typing speed).

    DESIRED QUALIFICATIONS AND EDUCATION:

    • Knowledge of insurance plans and benefits provided.
    • Strong knowledge and literacy in healthcare, finance, and banking terminology and products.
    • Proven ability to read and understand financial statements
    • Ability to problem solve.
    • Ability to provide on-time resolutions.
    • Ability to meet deadlines.
    • Customer support experience preferred.
    • Experience with customer relations management (CRM) software preferred.
    • Healthcare, insurance, or related industry experience preferred.
    • Demonstrated experience typing detailed notes and speaking on the phone at the same time.
    • Demonstrated experience navigating between multiple systems/platforms.
    • Proven time-management skills and patience.
    • Affinity for finding solutions to challenges.
    • Affinity for working in a fast-paced, exciting environment.
    • Affinity to go above and beyond to meet member's needs.
    • Intermediate experience working with Microsoft Office Suite (Word, Excel, Outlook, etc.) preferred.
    • Affinity for meeting or exceeding individual and team performance metrics.
    • Flexibility to work varied shifts, days, holidays.
    • Bilingual skills strongly preferred (English+ one or more of the following languages – Spanish, Cantonese/Mandarin, Korean, Vietnamese, Portuguese).

    ADDITIONAL NOTES:

    • Hours of Operation: 24/7/365
    • Shift bidding schedules

    NATIONSBENEFITS IS AN EQUAL OPPORTUNITY EMPLOYER.