Account Advisor I

Introduction

The Account Advisor I is responsible for resolving benefit and claims inquiries from members and providers via telephone and other approved channels within a call center environment. This role supports a positive customer experience while ensuring compliance with all applicable laws, regulations, and company policies.

Responsibilities

• Handle inbound inquiries related to benefits, claims, billing, and eligibility
• Research and resolve customer issues across multiple systems to ensure accuracy of benefits and payments
• Responding to inquiries regarding adjustments, refunds, and payment discrepancies
• Maintain up-to-date knowledge of policies, procedures, and regulatory requirements
• Document interactions and ensure completeness and accuracy of information
• Meet established customer service performance metrics (quality, productivity, customer satisfaction, attendance)
• Demonstrate ownership of issues and drive First Call Resolution (FCR)
• Perform other duties as assigned within scope

Requirements

Minimum Qualifications

• Education: High School Diploma or Equivalent
• Preferred Experience:
  • 1 year of customer service or medical office experience required
  • OR completion of BRCC Medical Assistant, Coding & Insurance pathway in lieu of experience
  • Call center experience preferred

Key Skills & Competencies

• Strong verbal and written communication skills with professionalism and empathy
• Ability to interpret and explain benefits, claims, and policies clearly
• Critical thinking and problem-solving skills
• Ability to multitask and manage multiple inquiries in a fast-paced environment
• Attention to detail and organizational skills
• Conflict resolution and ability to remain calm under pressure
• Active listening and effective questioning skills
• Proficiency in Microsoft Office and related systems
• Familiarity with healthcare/insurance terminology preferred

Work Environment Expectations

• Approximately 95% of time spent on phone in a call center environment
• May be required to work during emergencies or inclement weather
• Must successfully complete customer service training and demonstrate proficiency