Baylor Scott & White Health Customer Advocate Health Plan Jobs in Temple, Texas

Customer Advocate

Location: Health Plan

Department: Customer Service

Hours: Full Time


Required Experience 1+ Years

Required Education H.S. Diploma/GED Equivalent


Under general supervision, communicates to members and providers policy/procedures and services of the SWHP, and handles any complaints concerning the Plan by the membership. Works on the customers behalf to resolve any issues and/or concerns by going the extra mile, when needed.


With general supervision, communicates to members and providers policies, procedures and services of the SWHP to ensure complete understanding of the plan

Assist members with access to the Scott & White Health Plan system on a daily basis, and helps member choose an appropriate physician, and assist with appointments

Primary contact for benefits, claims status, simple drug inquires for Individual Plans with working knowledge of other products as business needs dictate based on first contact resolution guidelines

Verifies demographic information on all inquiries and updates as appropriate

Assists members with concerns and actively works toward a resolution before the concern escalates to a complaint

Accesses appropriate sources (BENS, Amisys, AboveHealth etc.) to obtain benefit information requested by member and/or provider

Acts as liaison between members, providers, and billing offices, with follow through to resolve issues

Accurately documents phone log records for each inquiry with appropriate messaging based on department standards

Adheres to behavioral performance standards

Must adhere to call handling goals of 80% of calls answered within 30 seconds

Supports and adheres to call abandonment rate of less than five percent (5%)

Average hold time must not exceed 2 minutes based on regulatory requirements

Supports and adheres to department behavioral standards (attendance, tardy, dress, etc) and identifies member¿s complaints and forwards to appropriate area; Scott & White Focus Standards of Behavior

Within 60 days of employment on the floor, must meet monthly quality goal of ninety-six percent (96%) or greater based on two percent (2%) of calls monitored

Supports and meets schedule adherence goals based on department policy

Successful completion of competency testing following initial Advocate training

Practices Advocacy behaviors with every customer interaction and promotes Service Excellence

Performs other position appropriate duties as required in a competent, professional and courteous manner


Must be proficient in typing and basic computer skills

Must successfully complete spelling, grammar and basic computer skills testing during job interview

Perform well in a fast-paced, stressful routine work environment

Practices good (consistent with SWHP standards) phone etiquette and uses effective communication skills (both verbal and written)

Familiar with policies, procedures and new products offered by Marketing and completes training as required

Must be able to multi-task

Must be knowledgeable in public relations with a diverse customer base

Must be able to problem solve and act as advocate for the customer

Must successfully complete Customer Service training and successfully pass competency exam to maintain CSA position

Job Family: Health Plan