„Cambia Health Solutions“ yra Portlande, Oregono valstijoje, veikianti ne pelno siekianti sveikatos priežiūros organizacija, siekianti, kad priežiūra būtų labiau orientuota į vartotoją. Būdama „Regence“ sveikatos draudimo planų šeimos pagrindinė organizacija, ji vykdo sveikatos draudimo ir su priežiūra susijusią veiklą bei investuoja į sveikatos inovacijas, įskaitant skaitmenines priemones ir paslaugas, skirtas pagerinti žmonių galimybes pasiekti sveikatos priežiūrą ir jų patirtį ja naudojantis.
Customer Service Ambassador – Partners in Care (Remote, United States)
Resolve complex member, provider, and claims-related issues as a Customer Service Ambassador with Cambia Health Solutions. Coach service teams and use trend analysis to strengthen member support.
Aprašymas
- Act as the Partners in Care department’s subject matter expert
- Coach and support Customer Service representatives
- Resolve complex and escalated calls, claims, and inquiries from members, providers, employer groups, and healthcare professionals
- Investigate claims, benefit administration errors, appeals, and correspondence issues in line with company policies and regulations
- Explain benefits, eligibility, claims procedures, pre-authorizations, and grievance and appeal processes
- Provide mentoring through individual guidance, help-line assistance, training, and onboarding
- Partner with Medical, Legal, Provider Relations, Claims, and Pharmacy Services teams
- Review data and trends to uncover recurring issues
- Deliver ongoing education and recommendations to Customer Service leadership
- Confirm that resolutions comply with corporate policies and regulatory requirements
- Advise on company policies, products, processes, and Coordination of Benefits
Reikalavimai
- High school diploma or GED
- At least three years of progressively responsible member service experience
- Equivalent education and relevant technical work experience may be considered
- Ability to report on and analyze trends, develop action plans, and assess outcomes
- Ability to evaluate member needs accurately, build rapport, identify errors, and determine corrective actions
- Reliable, member- and provider-focused approach with consistent adherence to departmental performance standards
- Experience with AI tools and technologies is strongly preferred
- A home-office setup with wired internet is required; satellite and cellular connections are not accepted, with minimum speeds of 5 Mbps upload and 10 Mbps download
- Personal mobile device for multi-factor authentication setup
- Successful completion of a background check
Privalumai
- 5% target bonus
- Medical, dental, and vision insurance for employees and eligible family members, including mental health coverage
- Annual employer contribution to a health savings account
- Paid time off that varies by role and tenure
- 10 company-paid holidays
- Retirement plan with company matching on employee 401(k) contributions
- Potential discretionary retirement contribution tied to company performance, with no vesting period
- Up to 12 weeks of paid parental leave, subject to eligibility
- Wellness programs that recognize participation
- Employee Assistance Fund
- Commuter and parking benefits
- Flexible work-from-home options
- Employee resource groups
- Opportunities to participate in Cambia-supported community outreach
- Required wired internet connection and minimum speeds for remote work
- Personal mobile device access for multi-factor authentication