Membership Service Advocate

Responsibilities

• Update account information including billing, address, and phone numbers
• Research premium billing discrepancies and prescription claims
• Educate beneficiaries on plan benefits, cost sharing, and coverage levels
• Verify medicine coverage, tiers, and copay levels via formulary
• Handle inbound and outbound calls with high accuracy and efficiency
• Maintain detailed and concise notations in member records
• Ensure compliance with HIPAA regulations and CMS Guidance
• Meet monthly goals for QA scores, attendance, and schedule adherence

Requirements

• Associate Degree, preferably in Healthcare
• Minimum 3 years in a high-volume call center, retail, healthcare, or hospitality environment
• Strong technical skills with Microsoft Office (Excel, Word, Outlook)
• Excellent written and verbal communication skills
• Ability to multi-task and navigate multiple systems simultaneously
• Strong problem-solving and de-escalation abilities
• Ability to explain complex information in simple terms

About the Company

Helpware is a technology-driven company that provides Customer Experience & Operational Support for modern companies, leveraging empowered teams and innovative solutions.