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Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
The purpose of this role is to interact with members regarding medical and pharmacy benefits, eligibility and claims issues and to assist with plan selection and enrollment. This role is expected to identify opportunities to connect members to the best resources to meet their healthcare needs and provide support in order to resolve medical and benefits issues on behalf of a member. The Bilingual Vietnamese Customer Service Advocate builds trust with members across their health care lifecycle.
- Provide in - language service to Vietnamese and English speaking customers over the phone
- Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the member
- Effectively refers and enrolls members to appropriate internal specialists and programs, based on members' needs and eligibility
- Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence.
- Resolve member service inquiries related to: Medical benefits, eligibility and claims, terminology and plan design, financial spending accounts, pharmacy benefits, eligibility, and claims, and correspondence request.
- Educate members about the fundamentals of health care benefits including: Managing health and well - being, maximizing the value of their health plan benefits, selecting the best health plan to meet their health needs, choosing a quality care provider and appointment scheduling, premium provider education and steerage, and pre - authorization and pre - determination requests and status
- Assist members in appointment scheduling to proactively address gaps in care
- Intervene with care on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed
- Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience
- Provide education and status on previously submitted pre - authorizations or pre - determination requests
- Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
- Maximizes use of community services, support programs, and resources available to members
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