Customer Success Agent III

Experience Level: At least 2 years in a call center customer service role. Health/Insurance background is preferred, though not required.

Location: Remote – USA, MST / EST Shift

SUMMARY

Antidote Health's mission is to redefine healthcare by providing affordable, high-quality, accessible care and insurance products. The Customer Success Agent III plays a key role in achieving this mission by delivering exceptional support to our health plan members, telehealth patients, brokers, B2B customers, and providers. We're looking for passionate individuals with experience in customer care, particularly in the health insurance industry to enhance and differentiate the customer experience.

Responsible for providing accurate, timely, and meaningful information to members and customers, ensuring stellar service in accordance with compliance and regulatory guidelines in a fast-paced inbound and outbound phone, chat, and email Customer Support Center.

This is a remote position with multiple shift options.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Provide service support to members, providers, brokers, and/or employers using one or more contact center communication channels and across multiple states and/or products including, but not limited to, phone, chat, email, and off phone work.
Build and maintain brand affinity by addressing questions, concerns, and complaints professionally while maintaining confidentiality in compliance with HIPAA guidelines
Accurately identify and explain Antidote HMO insurance plans, benefits, enrollment processes, EOBs, PCP selection, and referral/authorization for medical services, prescription coverage info, and other ancillary services (dental and vision).
Accurately and completely document pertinent details related to member, provider, and broker inquiries.
Coordinate and schedule telehealth appointments by effectively utilizing scheduling systems ensuring timely access to care, provide in-house clinician support by documenting clinician schedules, assist with technical support, and administrative functions to assist member.
Serves as an advocate between customers and network providers or other Antidote departments.
Assists in conducting customer satisfaction surveys and reports (e.g., CAPHS, QHP Enrollee Survey).
Assist with completing NCQA-compliant credentialing and responds to provider inquiries regarding the status of credentialing activities.
Demonstrate ability to quickly build rapport and respond to customers in an empathetic manner by identifying and exceeding customer expectations
Identifies, addresses, and documents member and customer complaints, grievances and appeals, determines the appropriate action, follows up to ensure resolution; and monitors trends to optimize customer satisfaction and remediate recurring issues in accordance with NCQA and regulatory processes and timelines.
Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or weekends, as needed.
Capable of meeting/ exceeding individual performance goals established for the position in the areas of: Call Quality, Attendance, Adherence and other Contact Center objectives.
Ability to proactively engage and collaborate with varies internal/ external departments/organizations.
Provides outreach calls to members and customers for issue resolution and follow-up,
Takes personal responsibility and accountability to provide resolutions in real time or through timely follow up with the customers.
Processes premium payment, reconciles and corrects payment discrepancies.
Coordinates translation services for members in accordance with Antidote’s Language Assistance Program.
Ability to effectively communicate professionally.
Manage medium and large projects or teams of staff under indirect supervision.
Performs other duties as assigned.

QUALIFICATIONS

To perform this job successfully, candidates must excel in each essential task. The requirements listed below represent the necessary knowledge, skills, and abilities. Reasonable accommodations can be made to enable individuals with disabilities to perform the essential functions:

Good critical thinking with a problem-solving approach.
Strong computer and phone skills, attention to detail, and adherence to processes and policies.
Excellent verbal and written communication skills.
Strong interpersonal skills.
Active listening skills to accurately respond to inquiries and requests.
Exceptional organizational skills, with the ability to retain and recall policies and processes.
Bilingual in Spanish is preferred.

EDUCATION AND EXPERIENCE

Experience with Google Workspace, Microsoft Office Suite, Monday Board, and internal communication systems such as Slack or Microsoft Teams.
Minimum three years of related experience in a high-volume phone, email, and text messaging call center.
Two years of call center experience in the health insurance industry is preferred.
Associate’s degree is required.
Salesforce experience is preferred.

CERTIFICATES, LICENSES, REGISTRATIONS

A Health Agent license is a plus but not required.

WORK ENVIRONMENT

This is a remote position.
Must have a quiet, distraction-free workspace to perform duties effectively from home.
Work location must be secure and private to maintain HIPAA compliance.
Office equipment will be supplied.
This position does not require travel.

TRAINING EXPECTATIONS

You will attend a minimum 4-5 week remote training program.
Attendance is mandatory for the full training program.
Training hours: Monday through Friday, 9:00 AM - 4:30 PM EST
You will be required to take regular open-book competency and retention exams during all weeks of training, with a passing grade of 90% or above.
No time off within the first 90 days of employment except for emergencies. If approved, any time off within this period will be unpaid.

WORK SHIFTS AVAILABLE

Shift flexibility is required. Shift availability is based on staffing needs, with no guaranteed shifts.
Available Full-Time shift options:
1) Sunday - Thursday
2) Tuesday - Saturday

Morning shift: 7:00 AM - 4:00 PM EST
Mid-shift: 10:00 AM – 7:00 PM EST
Late Shift: 4:00 PM – 1:00AM EST