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Member Services Advocate

Convey Health Solutions Yuma, AZ
  • Posted: April 21, 2019

External description: OTC Member Services Advocate ....
Receive inbound calls from health plan members enrolled into a Medicare Advantage or Medicaid program. Assist members with updating account information, providing OTC benefit information, resolving issues, and taking new orders or reorders via mail or telephone for OTC products approved by the plan
* I. ESSENTIAL DUTIES AND RESPONSIBILITIES
Update account information such as temporary changes of address for shipping or alternate phone numbers.
Educate members on how the supplemental OTC benefit works, including benefit amounts, and products available, and frequencey of coverage.
Identify member complaints and grievances and escalate according to client specific procedures.
Assist health plan members with inquiries related to their OTC benefits and/or orders placed.
Process requests for OTC items received from health plan members via mail or phone call
Look up over-the-counter medicines on the formulary to verify if they are offered, and if a drug is not offered provide an explanation as to why.
Make concise and detailed notations as it pertains to member records.
Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.
Conform with and abide by all regulations, policies, work procedures and instructions.
Respond promptly when returning telephone calls and replying to correspondence and faxes.
Act, dress, and behave in a professional manner to reflect a positive image of the company.
* II. OTHER DUTIES AND RESPONSIBILITIES
* Responsible for compliance with all federal, state and local laws, rules and regulations affecting Company.
* Responsible for participating in quality assurance, compliance and in-service and continuing education activities as requested by Company.
* Responsible for performing other duties and responsibilities as required.
Requirements
. High school diploma or equivalent preferred
6 Months customer service experience is preferred;
call center experience is helpful
Healthcare and/or pharmacy industry experience a plus;
or any equivalent combination of related training and experience
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Convey Health Solutions, Inc.
Yuma/W, AZ

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