Sr Advocate - FEP Customer Service

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

Want to know more? You can learn about life at Wellmark here.

Consider joining our Federal Employee Program team as a Sr. Advocate in Customer Experience.  In this role you will support the Federal Employee Program (FEP) business in Operations. You will serve as a resource for frontline Customer Experience Advocates who manage customer calls, written inquiries, and some claims functions, providing just-in-time feedback and coaching and supporting the Team Leader in daily functions. Recognize opportunities for improving processes and procedures, providing recommendations to FEP leadership and stakeholders based on data tracking, trending, and analysis to reduce waste and maximize performance for our staff. In this role, you will support change work being delivered within our Product teams and participate on agile teams, as needed; conducting thorough research and analysis of business processes to ensure our customers receive accurate, complete, and timely responses. As a subject matter expert, you will serve as a vital business liaison and technical resource collaborating across departments and divisions that support the Federal Employee Program. You will be influencing and guiding the implementation of new concepts, processes, and procedures that enhance overall customer service excellence. 

High School Diploma or GED

• A minimum of 3+ years previous experience in a customer support or engagement role, with demonstrated skills and the ability to pro-actively develop professional customer relationships through effective listening and understanding skills, and the ability to respond with solutions to customer needs.
  • 2 years’ proven subject matter expertise across multiple market segments, products, benefits plans, contract language, insurance rules and regulations.
• Excellent customer service skills using demonstrated communication skills, develops and maintains strong relationships by listening and understanding and responding to identified needs.
• Strong interpersonal skills, ability to coach others and build solid relationships with team members
• Ability to perform in a production based environment; demonstrated success working in an environment with aggressive time-lines and accuracy/quality measurements.
• Ability to effectively apply process steps and suggest and implement process improvements.
• Strong communication skills, both verbal and written, with the ability to concisely convey your message.
• Excellent problem solving and Microsoft Office skills.
• Effective prioritization, time-management and organizational abilities.
• Prior experience with workflow management and math skills.

Preferred:

• Associate’s degree
• Valid State of Iowa or South Dakota Insurance License.
• Prior experience in health insurance or related industry.
• Prior experience coaching or mentoring.
• Prior experience in claims administration or processing.

a. Serve as a business and technical resource to Customer Experience Advocates in handling customer (including complex) inquiries via phone, written, electronic or walk-in inquiries and the support of claims examination processes. Apply advanced skills and knowledge to investigate and resolve all customer inquiries. Partner and work with internal stakeholders to resolve issues, if necessary.

b. Provide support and guidance to team members in all market segments in-person or in a virtual environment. Successfully develop and maintain team member relationships through positive interactions. Research and coordinate with internal stakeholders to bring resolution to improve the customer experience. Communicate and confirm resolution with the customers.

c. Conduct training as needed and effectively provide quality assurance feedback in a professional manner. Will assess results and make recommendations for enhancements as needed.

d. Advocate value-based customer experience by providing guidance regarding call handling, health benefit/product education, or claims processing/payment inquiries. Continually monitor calls/trends and recognize opportunities to educate our Customer Experience Advocates.

e. Provide feedback and guidance in support of web and claims processing. Ensure adherence to processing procedures and the monitoring of aging reports.

f. Monitor and align work to team members and make adjustments as inventory fluctuates. Monitor and report workflow metrics and standards, in support of the management of performance measures.

g. Proactively communicate to appropriate stakeholders, leadership, training teams and production support. Work collectively with peers, systems and other technical teams to identify, solution, and research cross divisional issues (e.g. legislative mandates, process improvements or system integrations). Will review and modify workflows/processes, identify issues and opportunities.

h. Research and resolve inquiries where the customer has placed calls regarding an unresolved issue. Will research and coordinate with internal stakeholders to bring resolution to improve the customer experience. Communicate and confirm resolution with the member. Ensure customers understand their products, benefits, tools and how to use them.

i. Utilize technical knowledge and experience to perform as a “subject matter expert” in various initiatives and process improvement efforts. Identify and communicate the need to enhance desk level procedures and guidelines.

j. As needed, provide production support for calls, webs, and claims inquiries and serve as a back-up. Facilitate and teach customers to use appropriate resources/tools and how to access health care information to manage health care costs most effectively. Integrate Wellmark’s basic customer experience principles into day-to-day interactions. Anticipate customers’ needs to make it easy to do business with Wellmark.

k. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]

Please inform us if you meet the definition of a "Covered DoD official".