Universal Agent

Job Title: Universal Agent (EGWP)

Position Summary:

The Universal Agent is responsible for receiving, processing, and ensuring quality and efficiency of all incoming mail, enrollment and disenrollment requests and all other member correspondence. Their responsibilities also includes receive inbound calls from beneficiaries enrolled into a PDP or MAPD program. Assist beneficiaries with updating account information, providing plan information, resolving issues with utilization of the plan. Providing accurate and efficient customer service to members by way of inbound calls.

Essential Duties and Responsibilities: 
• Ensures proper processing of incoming, enrollment/disenrollment requests and all other member correspondence as it pertains to CHS/CMS compliance; proactively communicate findings.
• Update account information such as billing options and changes of address or phone numbers.
• Research billing discrepancies and prescription claims processed.
• Educate beneficiaries on how the plan works, including benefits, cost sharing, and levels of coverage.
• Submit mail requests for beneficiaries such as ID cards and formularies.
• Look up medicines on the formulary to verify if they are covered, the tier and copay level, and if a drug is not covered, provide an explanation as to why.
• Displays positive demeanor, technical accuracy, and conformity to company policies.
• Understands CMS Guidance and ensures mailing of applicable Exhibits per CMS Guidance.
• Maintain HIPAA regulations within the immediate environment.
• Responsible for concise and detailed notations as it pertains to member records.
• Handles outbound calls for purposes of validating information.
• Handles inbound calls by assisting members with a high level of accuracy and efficiency.
• Escalates any member issues to management as necessary.
• Responsible for maintaining a high level of call quality as set by client standards.
• Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.
• Conform with and abide by all regulations, policies, work procedures and instructions.
• Respond promptly when returning telephone calls and replying to correspondence and faxes.
• Act, dress, and behave in a professional manner to reflect a positive image of the company.

Education and Experience: 
• Associate's degree (A. A.) or equivalent from two-year College or technical school preferred.
• Minimum of six months related experience in people and process management, data analysis, and error correction or any equivalent combination of related training and experience.
• Part D Document Processing Specialists may be required to have a 240 Health Insurance License

Knowledge, Skills, and Abilities:
• Ability to provide clear and accurate information and follow up when necessary
• Ability to multi-task - effectively self-manage time and multiple projects simultaneously with strong attention to detail.
• Ability to solve problems - identifies and resolves problems in a timely manner gather and analyze information skillfully, develop alternative solutions, work well in-group problem solving situations, and use reason even when dealing with emotional topics.
• Requires technical skills - Assess own strengths and weaknesses, pursue training and development opportunities, strive to continuously build knowledge and skills, and share expertise with others.
• Ability to speak effectively before groups of customers or employees of organization.
• Ability to speak clearly and concisely over the phone.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to deal with problems involving several concrete variables in standardized situations.
• Skill in dealing politely, tactfully and firmly with a wide range of people and personalities.
• Skill in communication and interpersonal skills sufficient to exchange or convey information and to receive work direction.
• Skill in organizing and prioritizing tasks.
• Knowledge of business English grammar, spelling and composition.
• Must be able to multi-task and think quickly.
• Ability to interact professionally and maintain effective working relationships with superiors, coworkers, customers, and others.
• Ability to be flexible and juggle many assignments or projects at the same time.
• Working efficiently in a stressful environment.

About Us
Convey Health Solutions, together with Pareto Intelligence™, delivers a powerful combination of purpose-built technology, advanced analytics, and expert services to help health plans thrive in a complex, post--Affordable Care Act environment.

As a trusted partner to Medicare and commercial payers, we provide scalable, compliant solutions that span the entire member lifecycle--from enrollment and billing to risk adjustment, Stars performance, and member engagement. Pareto's deep analytics and financial intelligence complement Convey's operational expertise, enabling our clients to improve performance, reduce costs, and create better healthcare experiences for millions of Americans--especially seniors and vulnerable populations.

Together, we help health plans scale smarter, grow stronger, and make healthcare work better for the people who need it most. Learn more at http://www.ConveyHealthSolutions.com