Broker Concierge Sales and Service Associate II

Job Summary:

The Broker Concierge Sales and Service Associate II primarily serves as a dedicated operational advocate for CareSource's highest performing brokers, agencies and FMOs. Provides high-touch, personalized support by owning complex pre and post enrollment issues including member onboarding concerns, provider and network inquiries, benefit and eligibility questions, billing issues and general service escalations through final resolution.

Essential Functions: Responsible for researching and resolving issues spanning the pre and post enrollment process for Broker enrollees with a focus on first call resolution or ongoing case management through resolution.

Collaborates with the various departments virtually, to resolve member related issues and broker escalations, to provide a comprehensive resolution.

Exercises independence to complete Broker related research, fulfillment, and inquiry requests efficiently and timely.

Accesses and extracts data from a variety of primary and secondary sources and in a variety of formats as part of the resolution process.

Conducts thorough research of ancillary vendors third party systems, health plan sites, portals, internal reference material, and custom tools to identify accuracy of information and identify root causes of issues.

Responsible for timely and effective processing of any aging inventory of broker/member requests, to full resolution.

Works closely with other business owners to identify root causes of issues and resolve barriers experienced by members.

Accesses and understands all related benefit coverage resources, tools, and materials to respond to a member’s inquiries and concerns correctly.

Thoroughly logs all broker interactions into appropriate databases for purposes of accurate tracking and analysis.

Troubleshoots escalated member related issues reported by brokers.

Performs follow up calls to members and brokers for dental, pharmacy, and other benefit inquiries that were not a one call resolution, including processing pharmacy overrides and rejections for members/brokers.

Adhere to all departmental and company policies and procedures.

Assist prospective members with selecting and enrolling in the CareSource exchange health plan by educating members on our benefits and services, educating members on plan premiums, co-pays and coinsurance, answering all Healthcare Exchange inquiries, and assisting with the application process for enrollment.

Serve as a subject matter expert on CareSource exchange healthcare plans and product lines.

Perform any other job related duties as requested.

• Education and Experience: High School or GED required
• Associates degree preferred
• Three (3) years of customer service, sales support or other related experience required
• Commercial insurance sales experience preferred
• Competencies, Knowledge and Skills: Computer proficiency with knowledge and experience in a Windows environment
• Typing speed of 35 words per minute (WPM)
• Maintain regulatory knowledge for compliance to ODI, CMS, and CareSource requirements
• Strong written and verbal communication skills
• Professional phone etiquette
• Proper use of grammar
• Ability to work in a fast paced environment
• Adaptable to a constantly changing environment
• Customer service experience
• Solid self-management and time management skills
• Ability to work effectively independently and within a team environment
• Critical thinking and listening skills
• Decision making and problem solving skills
• Demonstrates confidence and positivity
• Sales skills to meet enrollment objectives
• Professional telemarketing skills

Licensure and Certification: Current, unrestricted State Insurance license in Accident and Health in state of practice within state(s) of assigned territory may be required or ability to achieve license(s) within 30 days of hire preferred

• If a Federally-Facilitated Marketplace (FMM) State, certification from the Health Insurance Marketplace and annual recertification each year thereafter preferred
• Working Conditions: General office environment; may be required to sit or stand for extended periods of time
• Will work in a phone queue; Required to use general office equipment, such as a telephone, photocopier, fax machine, computer
• Travel is not typically required