Family Health Advocate - Remote

Job Summary

The role of the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to members and their families through personalized resource and referral facilitation, issue resolution and healthcare navigation.

Essential Job Functions

• Answer inquiries from members (via voice and chat) for the following:
  • Help with eligibility, benefit education, open enrollment / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, dental, and vision plans
  • Provider search (PCP, specialty, and facility), focused on healthcare cost and quality, and present premier provider options, including but not limited to medical, dental, and vision plans
  • Support for spending accounts, pharmacy, and disability
  • Aid with ordering durable medical equipment (DME)
  • Community resource search
  • Member preferences management
  • Care coordination with providers, payers or 3rd parties for: Claims adjustments, Grievances and appeals submissions, Utilization management intake or status, Complex pharmacy inquiries, Complex spending account inquiries
• Provide proactive care guidance for various value-add opportunities:
  • Guidance on closing care gaps (e.g., No PCP, discussing switching from low quality PCPs to high quality PCPs, reminder for completion of health risk assessment, reminders for exams/tests due)
  • Proactive benefits education for procedures
  • Preparing members for scheduled procedures/admissions
  • Referring members to available 3rd parties for care management and second opinion
  • Referring members to Clinical Advocates (Nurse) for conditions that require clinical care and case management assistance
• Primary duties include but are not limited to:
  • Understands and communicates the benefit design packages to members as defined by employer
  • Interacts with members verbally and in written form to ensure appropriate engagement is achieved
  • Is fully versed in and can explain plan benefit design, handles benefit and enrollment issues
  • Drive member's engagement into appropriate programs and offerings
  • Be an educator on health care related inquiries

Specific Skills/Attributes

• Excellent multi-channel communication and problem-solving skills
• Ability to communicate effectively in both voice and chat channels, including critical thinking skills, effective typing, grammar, and spelling skills

Qualifications

• High school / GED diploma
• 2-yr associates degree in healthcare/health sciences OR equivalent experience in healthcare, preferably helping members navigate benefits and claims
• Held one or more of the following positions: Health Guide/Advocate/Navigator, Medical Assistant, Pharmacy Technician, Phlebotomy Technician, Electrocardiograph (EKG) Technician, Patient Care Technician (PCT), Physical Therapy Assistant, Nursing Assistant, Medical Secretary/Clinic Manager, Radiology Technician, Home Health Aide, Occupational Therapist Aide, Medical Coder, Dental Assistant
• Experience in customer service in a healthcare contact center, provider office, or healthcare institution
• Experience in successful resolution of high level/sensitive customer service issues