Meridian, ID, United States
Bilingual, Customer Service, Administrative
Nov 24, 2020
Mar 09, 2021
Member Care Advocate (Inbound Contact Representative 2) - English OR Bilingual English and Spanish Fluent Positions Available
The Inbound Contacts Representative 2 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
The Inbound Contacts Representative 2 serves as a member advocate, addressing customer needs, which may include acting upon complex benefit needs, resolving grievances, and educating members. The ICR 2 documents member inquiries and resolutions provided per Centers for Medicare and Medicaid compliance criteria. The ICR 2 role intakes calls, makes outbound calls, resolves grievances and follows the escalation protocol when necessary to address member needs. ICR 2 role must adhere to the member services department protocols that speak to plan benefits as well as align to CMS mandates in the handling of organization/coverage determinations, grievances and appeals. This role is a highly structured role requiring continuous referencing of policies and protocols. Active listening and the intention to work in a proactive manner is key to success in the role. Role does require ongoing receptiveness to training and performance feedback, as compliance mandates are continuously updating and we are audited against our adherence to these.
This is a customer-centric member advocate environment focused on high quality outcomes versus activities. Our department primarily communicates over the phone, but we are not a 'call center' environment as we are responsible for the member's safety and advocacy outcome as part of the continuum of their care. We value quality work as every action taken in the member services department is to facilitate access to the member and avoid adverse outcomes for the member.
Associates can expect to take anywhere from 25 to 35 inbound calls per day with the focus being on high-quality service with a strong emphasis on member advocacy and patient safety.
While this associate receives inbound calls, up to 60% to 70% of these calls may require associates to place outbound calls to physicians, DME vendors, pharmacies or other entities to coordinate benefits and care for the member.
This role calls for strong emotional intelligence focused on proactively providing solutions, ensuring the member's utmost health and safety. De-escalation skills are a must to thrive in this role. We serve a wide variety of members, some of which are experiencing illness and trauma at the time of their call.
Education, Experience, Skill set:
High School Diploma or Equivalent
2 years of customer service experience such as in a Physician Medical Office, Clinical Unit/Office Coordination role, or any experience working with irate member population requiring high degree of organization, structure and focus.
Candidate must be interested in the health insurance industry, Medicare Care Advantage industry, or compliance industry as this opportunity is not a job, but an opportunity to learn the intricacies of a Medicare Advantage Prescription Drug Plan (PDP). This role is a learning opportunity to build a career from. Candidate must understand they will serve the member as a 'Universal Agent' which requires knowledge and mastery of multiple disciplines such as but not limited to: pharmacy; plan medical, dental & vision benefits, case management, compliance requirements and more.
Excellent verbal and written communication skills
Must be willing to comprehend complex compliance mandates and inter-dependencies that exist within the operation.
Ability to maintain a professional demeanor, practicing strict confidentiality on all platforms for all sensitive information
Ability to focus on the training and role without significant interruption during the workday.
Strong initiative with the ability to adapt to change as the business requires.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must have the ability and willingness to be selfless and focus on the member as the priority throughout the workday.
Technology,, System, and Platform Knowledge
Strong computer skills and utilizing multiple systems and applications simultaneously is required as this is a work at home role. Must be comfortable with gaining new systems knowledge at all times as software is constantly updating requiring the ability to learn systems real time. The following is required to ensure success in the role as a remote work at home associate:
Must be proficient in Microsoft Word such as Word, Excel, Outlook/WebEx, Skype and using collaborative platforms for network sharing examples such as SharePoint, and Teams
Must have experience using vendor applications examples such as Salesforce, and department CRM Platforms.
Must be able to pass the following pre-hire assessments, (Please review in the below additional information):
Virtual Job Experience Assessment
A writing assignment may be requested during interview
A language assessment may be performed for English and or bilingual Spanish during screen and/or interview.
Anticipated Start Date/Training Date Depending on Interview Schedule
: 14 September, 19 October 2020 or 2 November
Hours - Adherence to the following schedule:
Regular Hours and Training Hours: Any 8-hour shift between the hours of 8:00 AM to 8:00 PM local time Monday through Friday
Flexibility to work weekends, holidays and/or mandatory overtime based on business needs
Ability to work any scheduled day and time during open enrollment, which is between 1 October and 31 March with mandatory overtime as needed.
Schedule changes occur on average 2 times a year to respond to business need and are generally provided 2 weeks in advance. If there is an immediate business need to adjust schedules, employees are expected to make the accommodation as soon as the business requires it but no later than 48 hours.
Remote/Work at Home
* Please review Work at Home Guidelines below
United States, excluding Alaska and Hawaiii
Language Fluency Requirement
Bilingual English and Spanish fluency
The interagency Language Rating, (ILR), test may be requested as required by the Federal Government under the Federal Care Act, to ensure competency.
Associates or Bachelor's Degree
Experience and/or background with case management processes
Member Advocacy Experience
Healthcare/Medical Insurance experience
Government Compliance experience
Additional Information - Please Read Full Details Below
Interview and Remote Work at Home Requirements
: - In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring/new hire activities. This position provides an opportunity to work at home.
For Interview Purposes:
Access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m,
Dedicated secure home workspace for interview or work purposes.
Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)
Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy during work hours.
The following equipment will be provided: laptop, Two Monitors, mouse, keyboard, Avaya phone system that connects to laptop, and modem cable to hard wire connect laptop
Humana does not cover reimburse costs to set up a home office, or monthly internet service
Customer Care Assessment / Virtual Job Experience:
After submitting your application, if you are selected to move forward you will receive an email to complete the Virtual Job Experience (VJE). This is an online activity where you will learn more about Customer Care jobs at Humana, try out some of the most common job tasks, and tell us more about yourself.
Most people complete the VJE in approximately 30 minutes. To complete it, you will need a smart phone, computer or tablet with internet access, and speakers/headphones.
Candidates will not be reviewed for consideration if the VJE, is incomplete.
The email will come from email@example.com please add to your contacts or safe senders list to avoid this going to your spam folder.
As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
You will be able to respond to the recruiters preferred response method via text, video or voice technologies
If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate.
You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Continuous New Hire Testing/Assessments:
The CarePlus team provides a thorough training program consisting of at least 12 weeks. Ability to pass required new hire assessments that are required to remain in the position, which includes:
10 mini exams throughout the entire training
Mid-term to ensure competency during training
Final that needs to be meet passing grade
Work At Home Guidelines
: This role is full-time remote/work at home.
Time Off Requests:
Humana is regulated by the Center for Medicare and Medicaid Services and maintain a high level of commitment to our members. For this reason, time off and scheduling are heavily based on business need so we can provide the best service to our membership.
The training and onboarding for this position is critical for your development as an associate. Time off and scheduled obligations during the first 120 days will be evaluated as part of the selection process.
Transfer Timeline Within Humana:
Must serve a minimum of 2 years within this department before transferring to another department.
Scheduled Weekly Hours
Website : http://www.humana.com