Participant Advocate Customer Service Rep

The Participant Advocate is responsible for delivering a superior participant experience by providing sincere, empathetic, accurate, and efficient service in every interaction. This includes managing phone calls, emails, and written correspondence with participants, local union and employer contacts, providers, vendors, and fellow advocates with professionalism, courtesy, and attention to detail.

Responsibilities

• Develop and maintain a comprehensive understanding of the FMCP Summary Plan Description, including benefit schedules, the eligibility system, claim payment system, and the Reciprocity system (ERTS).
• Ensure exceptional participant experience by consistently offering support and promoting satisfaction.
• Respond promptly and accurately to phone calls, emails, in-person inquiries, and written communications, including answering questions, explaining claim payments, addressing claim denials, quoting self-payment amounts, verifying eligibility and benefits, and researching eligibility or claim issues.
• Update participant eligibility with outside vendors as necessary.
• Maintain a professional, compassionate, and empathetic demeanor in all interactions.
• Escalate participant-related concerns to appropriate individuals for prompt resolution.
• Accurately and promptly document all phone calls in the Customer Service module.
• Perform clerical duties, including processing enrollment forms and working spouse forms.
• Navigate and provide clear guidance on the FMCP website for participants.
• Monitor incoming calls and handle waiting calls via the call management system.
• Manage messages from the Nightline system.
• Assist with special projects as directed by management.
• Perform other duties as assigned.