A successful candidate will deliver outstanding service to members regarding health insurance products administered by Wellfleet. Responsibilities include answering benefit questions, investigating claims, providing requested information, and assisting members throughout their healthcare experience to boost satisfaction and promote better health outcomes. The Member Advocate promotes self-service options for efficient issue resolution, ensuring every caller receives smooth, high-quality support in line with company policies and industry standards. This role requires staying informed about relevant industry developments and regulatory requirements to ensure compliance. You must be able to work until 5pm, PST to meet West Coast customer needs.
In this role, you will…
- Maintain knowledge of health insurance products serviced at Wellfleet
- Have the ability to work until 5pm, PST to meet West Coast customer needs
- Stays abreast of relevant business and industry developments and regulatory requirements to ensure compliance
- Manage calls effectively, focus on active listening, clear and professional communication, and efficient call handling techniques to honor commitments made to our customers
- Respond to calls promptly, ask clarifying questions to understand what the caller needs, express empathy, give accurate information, and take responsibility for solving problems or escalating them as necessary
- De-escalate difficult or challenging phone calls professionally and effectively
- Handle a high volume of inbound member inquiries via telephone, email, and chat in a timely and efficient manner
- Maintain an ongoing understanding of internal department and business processes
- Own the member experience to assist with navigating the healthcare journey; via education on our tools, responding to calls, emails, and chats timely/efficiently
- Successfully and efficiently navigate the systems utilized within the department
- Meet and consistently maintain the Quality and Schedule Adherence standards as established by the customer service leaders
- Comprehend and interpret documents, such as training manuals, correspondence, brochures, etc.
- Multitask throughout the day to ensure expectations and department goals are met
- Maintain a positive and professional attitude while staying engaged and motivated to achieve success as an individual and as part of the team
- Attend trainings and other company/team meetings with camera participation
- Ensure full functionality of equipment to perform job duties efficiently and effectively. This includes prompt reporting of any system or equipment issues to supervisor (or proxy) and submitting timely IT ticket, as appropriate
- Identify and communicate trends that are indicative of enterprise service issues
- Perform other duties as assigned.
We are looking for candidates with…
- High school diploma and a minimum of 3+ years’ work experience in customer service in a health insurance setting or medical billing office
- Familiar with medical terminology, health plan documents, or benefit plan designs
- Call Center experience with strong customer service skills
- Demonstrated experience in utilizing digital platforms and systems to manage calls, chats, and emails
- Strong written, verbal and interpersonal communication skills
- Excellent professional phone etiquette, genuine enthusiasm for providing service to others, and the capacity to communicate with empathy
- Outstanding attention to detail and possesses strong time management abilities
- Skilled in decision making and problem solving
- Commitment to help resolve inquiries at the first point of contact
- Ability to think outside of the box to resolve complex member inquiries
- Strong work ethic with a deep sense of accountability towards your teammates and our members
- Dependable with a dedication to excellence and commitment to attendance and punctuality (being at workstation at the proper time each day, fully able and willing to work)
- Familiar with Microsoft Office and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
- Capable of managing multiple tasks at once while consistently upholding integrity and delivering high-quality service
- Ability to adapt within a dynamic work environment; willingness to work a flexible schedule and overtime when needed
- Maintain a separate, dedicated work area, that provides information privacy without distraction.
New hires participate in an on-site orientation at our Springfield, MA office location during their first week. This program is designed to introduce you to our team, culture, policies, and operational procedures, ensuring you have the tools and knowledge to succeed in your role. You will also receive hands-on training specific to your position and have the opportunity to connect with colleagues.
