Position Summary

As a Customer Advocate, you will be supporting communication between MedRisk/SPNet's network providers and referring adjusters and nurse case managers. You will report to the Customer Advocate Team Lead and/or Supervisor to help strengthen MedRisk/SPNet's referral process, ensuring efficient workflow, while increasing customer satisfaction. Acting as liaison, the Customer Advocate tracks patient progress from the start of treatment, throughout treatment, and through to closure by obtaining relevant case updates from providers, including but not limited to dates of service, compliance, treatment notes, and continued authorization. They are responsible for maintaining the integrity of the case file and related documents and communicating professionally and effectively with the customer.

Primary Duties & Responsibilities

Level I:

Manage claims and monitor case status by confirming patient attendance with network providers, and addressing any concerns regarding compliance

Properly update all case related data to MedRisk's database/platform

Track and relay authorization to our providers as directed by the clients with confirmations to the adjuster and NCM

Be knowledgeable regarding the client's unique needs and respond appropriately

Build approachable, professional relationships with providers and referring customers.

Compliance with HIPAA and URAC guidelines

Employee is expected to work a minimum of 60 tasks daily

Level II: In addition to the Level I duties and responsibilities-

Assist with training/shadowing new hires and provide constructive feedback on their progress
- Identify additional areas of support post training
- Provide proper support within system navigation

Assist with escalated and time sensitive client and customer requests

Complete special projects as assigned

Provide coaching opportunities for peers to Team Leads and Supervisors as identified

Level III: In addition to the Level I & Level II duties and responsibilities-

Be a subject matter expert in workflows/processes

Provide coaching opportunities for peers to Team Leads and Supervisors, as identified

Actively participate in assisting Trainers on workshops and training the team

Become valued contributors within the Senior Mentor Program

Build strategies for more efficient workflows within our systems

Qualifications

Bachelor's Degree preferred; impeccable customer service skills with 2-3 years of experience preferred

Healthcare experience required; minimum of 1 year preferred

Experience working with a US company (PH specific)

Ability to work independently and multi task in a fast paced environment

Detail oriented

Excellent verbal & written communication skills

Basic knowledge of Microsoft Word, Excel, Outlook and Zoom

Computer skills in Windows environment

Time management and strong organizational skills

Adaptability

Ability to receive constructive feedback

Strong work ethic

Competencies (choose at least 4)

Customer Focus

Comprehensive Computer Skills

Listening

Informing

Action Oriented

Ethics and Values

Priority Setting

Integrity and Trust

Working Conditions & Physical Requirements

Office & Home environment

While mostly sedentary, the job includes walking, standing, sitting, possible twisting, kneeling

Visual acuity (color, depth perception and field of vision)

Substantial movements (motions) of the arms, wrists, hands, and/or fingers

This position requires consistent communication both verbally and electronically. Candidate must be able to utilize exceptional verbal and written communication skills.

Customer Advocate Level I