Job Description

Position: Customer Engagement - Advocate

Location: Reston, VA #HYBRID

Duration: 12 months #Contract

Rate: $20/hr

Job Description :

• Responsible for answering member, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment.
• Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs.
• Provides basic technical assistance and troubleshooting guidance for digital and electronic applications.
• Education Level: High School Diploma or GED
• 3+ year customer service experience
• Successful completion of the training provided., Proficient
• Demonstrated skills as an empathetic and compassionate communicator., Proficient
• Ability to quickly gain customer trust and confidence., Proficient
• Demonstrated PC navigation and data entry skills., Proficient
• Strong interpersonal communication skills., Proficient
• Good oral and written communication skills., Proficient

Top 5 Required Skills :

1. Strong Communication Skills:

• Clear verbal and written communication is essential for explaining complex Medicare benefits and resolving member concerns.
• Associates must be able to simplify jargon, speak with empathy, and maintain professionalism across diverse populations.

2. Technical Proficiency:

• Comfort with CRM systems, call center software, and Medicare databases is vital.
• Associates should be able to navigate multiple systems simultaneously, enter data quickly, and troubleshoot basic tech issues.

3. Emotional Intelligence and Patience:

• Medicare members may be elderly, frustrated, or confused. Associates need active listening skills, patience, and the ability to stay calm under pressure.
• Building trust and rapport is key to member satisfaction and retention.

4. Attention to Detail:

• Call center reps must accurately document member interactions, verify personal and plan information, and follow compliance protocols.
• Mistakes can lead to coverage issues or HIPAA violations, so precision is non-negotiable.

5. Knowledge of Medicare Guidelines:

• A solid understanding of Medicare Parts A, B, C, and D, eligibility, enrollment periods, and coverage rules is critical.
• Associates often handle policy-specific questions, so familiarity with CMS regulations and plan structures helps ensure accurate support.

ESSENTIAL FUNCTIONS :

45% Provides first- level problem resolution to member, provider & broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures.

25% Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. Appropriately documents all client interactions according to established departmental procedures.

15% Delivers accurate information to customers in accordance with performance goals and objectives.

10% Maintains customer records by updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes.

5% Participates in ongoing education related to new services, industry topics, and skills.

Thanks & Regards,
--

LAXMAN
Team Lead - Talent Acquisition

KMM Technologies, Inc.
CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified
WOSB, SBA 8(A), MDOT MBE & NMSDC MBE
Contract Vehicles: 8(a) STARS III & Schedule 70
Tel: (240) 800-0039 |Email: [email protected]

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