Shamara Jackson

Behavioral Health Customer Advocate - Customer Advocate II

• Assist with inquiries regarding behavioral health benefits, insurance policies, claims, and services; providing expert support and case management to ensure access to care, specific benefits, and service.
• This role required strong communication skills to assist members and providers, coordinating with internal departments, and complex healthcare contracts and policies.
• Assist members with inquiries about their health insurance plans, benefits, claims, and enrollment, providing prompt, accurate support via various communication systems and channels.
• Provide customer support; Answer member questions, explain medical and dental benefits and packages, and guide customers to the correct information.
• Inbound/Outbound Support: Respond to member and provider inquiries via phone, email, or other channels to address questions about behavioral health benefits, coverage, and claims.
• Resource Provision: Provide members with information and resources related to behavioral health conditions, treatment options, and available services.
• Care Coordination: Coordinate with members, their families, physicians, and other providers to ensure appropriate care and facilitate access to behavioral health services.
• Internal Collaboration: Liaise with other departments, such as claims, enrollment, and care management, to gather information and resolve issues efficiently.
• Resolve Inquiries & Complaints: Research and resolve member issues, complaints, and claims in a professional, timely, and courteous manner.
• Interpret Policies & Procedures: Understand and explain complex health insurance policies, contract benefits, and legislative requirements.
• Document & Record Keeping:Maintain accurate records of customer interactions, complaints, and feedback.
• Fraud & Error Detection:Identify, report, and refer suspected fraudulent activities and system errors to the appropriate departments.
• Enhance Member Satisfaction:Work to enhance member and provider satisfaction and retention by providing excellent service.

• Entered patient data into electronic health records accurately.
• Verified and corrected discrepancies in data entries systematically.
• Maintained confidentiality of sensitive health information diligently.
• Assisted in training new staff on data entry protocols consistently.
• Monitor incoming faxes and triage documents by reviewing their contents and routing them to the appropriate medical staff or department.
• Review electronic medical records to fax documentation to providers and other healthcare organizations. The specialist must confirm all documents are properly executed and sent to the correct recipient.
• Track and research any failed electronic faxes or returned mail. The specialist is responsible for resending the documents to ensure they are delivered without violating privacy regulations.
• Maintain confidentiality: Handle all patient-related information in strict accordance with HIPAA and other privacy regulations to prevent data breaches.
• Research missing provider or facility contact information and update internal systems accordingly; update patient records and demographics in the Electronic Health Record (EHR).

This position required strong patient advocacy, accurate record-keeping, and the ability to explain program requirements and benefits.

• Processed enrollment applications for new members efficiently and accurately.
• Coordinated communication between members and healthcare providers for benefit clarification.
• Verified member eligibility through comprehensive review of documentation and records.
• Guide patients in navigating and applying for programs that cover the cost of prescription medications.
• Gathered demographic and financial information, prepared and submitted applications for pharmaceutical company assistance programs, & followed up to ensure the enrollment process was complete.
• Maintain accurate and complete records of all patient encounters and enrollment activities using electronic systems and applicable forms
• Regularly follow up with pharmaceutical companies and doctor's offices to ensure that applications are processed correctly and that ongoing paperwork is completed.
• Assist with the automatic management of prescription refills to ensure patients' continued access to medications

• Supported and maintained enterprise applications, training users, and provided technical expertise for implementation and optimization.
• Documented support processes and created user guides for software applications.
• Assisted users in navigating applications and resolving functionality queries.
• Provided technical support for application issues across diverse user groups.
• Collaborated with development teams to troubleshoot software problems effectively.
• Monitored application performance and identified areas for improvement proactively.
• Work with teams to implement complex technical solutions that meet business requirements.
• Collaborate with end-users, team members, and other departments to solve challenges.
• Provide reports, data extractions, and information from enterprise systems.
• Install, configure, and maintain specific software applications.
• Identified root causes of application errors and implemented solutions to prevent recurrence.
• Design and implement procedural systems for effective application use.
• Developed and implement custom solutions, including web portals and system linkages.

• Servicing inbound calls from current policyholders with the intent of cancelling their insurance benefits.
• Answering questions regarding coverage, premium and other policy information.
• Composing business letters, communicating effectively through written and verbal communication.
• Assisted in developing customer retention strategies and initiatives.
• Delivered exceptional customer service by patiently listening to customer concerns or complaints.
• Working independently and making judgment decisions is required.
• Making outbound calls to existing policyholders to collect delinquent premium payments.
• Reselling the benefits of our policies and providing excellent customer service.
• Using various sales techniques to help increase the retention of our policyholders.
• Recording policyholder information for reporting and transactional purposes.
• Extensive telephone contact and appropriate telephone skills are required.
• Discretion and tact must be used in providing service to customers.

• Servicing inbound calls from current policyholders with the intent of cancelling their insurance benefits.
• Answering questions regarding coverage, premium and other policy information.
• Composing business letters, communicating effectively through written and verbal communication.
• Working independently and making judgment decisions is required.
• Making outbound calls to existing policyholders to collect delinquent premium payments.
• Reselling the benefits of our policies and providing excellent customer service.
• Using various sales techniques to help increase the retention of our policyholders.
• Recording policyholder information for reporting and transactional purposes.
• Extensive telephone contact and appropriate telephone skills are required.
• Discretion and tact must be used in providing service to customers.
• Assisted in developing customer retention strategies and initiatives.
• Provided support during policy renewals and updates for clients.
• Maintained updated records of customer interactions and inquiries.

• Assisted customers with inquiries and provided accurate product information.
• Resolved customer complaints promptly and effectively through active listening.
• Processed orders efficiently using customer management software systems.
• Collaborated with team members to enhance overall service delivery standards.
• Maintained detailed records of customer interactions for future reference.
• Coordinated with other departments to address complex customer issues promptly.
• Provided excellent customer service to resolve customer complaints in a timely manner.
• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
• Remained calm and professional in stressful circumstances and effectively diffused tense situations.
• Developed strong customer relationships to encourage repeat business.
• Developed strong relationships with customers by providing personalized assistance and support.
• Performed administrative tasks such as filing paperwork, updating databases and generating reports.
• Asked probing questions to determine service needs and accurately input information into electronic systems.
• Provided exceptional customer service to ensure customer satisfaction.