Health Services Patient Advocate

Building Services 32BJ Benefit Funds (“the Funds”) administers Health, Pension, Retirement Savings, Training, and Legal Services benefits to over 100,000 SEIU 32BJ members. Our mission is to provide high-quality benefits and services, guided by the core values of Flexibility, Initiative, Respect, Sustainability, and Teamwork (FIRST). The Funds manages $9 billion in assets and leverages cutting-edge technology such as M365, Dynamics 365 CRM, Dynamics 365 F&O, Azure, AWS, SQL, Snowflake, and QlikView.

About the role

This position is a key part of developing, expanding, and maintaining the Health Fund programs. The Health Services Patient Advocate is responsible for maintaining relationships with 5 Star Centers, supporting Health Fund program operations, responding to member and provider issues, and assisting members in choosing in-network providers, particularly 5 Star Centers and partnered providers.

Responsibilities

• Cultivate relationships with management and administrative staff at specified 5 Star Centers to assist in addressing member issues from initial inquiry to resolution.
• Assist members with selecting appropriate providers based on medical criteria and scheduling appointments at 5 Star Centers.
• Review cases and communicate advantages of medical options, including limitations or alternatives available to members.
• Investigate member complaints and serve as an advocate when a complaint is filed against 5 Star providers to determine a resolution.
• Identify patterns and trends in Health Fund program issues with service provision and address or notify management accordingly.
• Address member concerns about Fund programs and complete program enrollment processes for eligible members.
• Utilize the Health Services Database to track interactions related to fund programs.
• Work with members and providers to verify correct copays and research claims to identify billing errors.
• Handle cases involving out-of-network and non-preferred providers, offering in-network and preferred alternatives.
• Confirm provider network status, including situations where providers may have varying statuses at different sites, by contacting provider offices directly.
• Conduct research on uncommon procedures and verify provider capability to assist members in making complex care decisions.
• Perform side-by-side shadowing with new employees on workflows, systems, and case management processes.
• Perform other tasks and special projects as required by management.
• Reach out to members and dependents who meet specific criteria for upcoming fund initiatives and programs.
• Contact members unresponsive to third-party administrators and vendors to ensure correct processes are followed.
• Handle escalated outreach requests and receive incoming calls through the Health Services queue regarding Health Fund Programs, billing/claim issues, and medical services.
• Direct escalated claim issues to management and Claims Specialists, relaying outcomes to members.
• Back up the member services provider line queue for provider search activity upon request.
• Attend and participate in all team meetings.
• Log member issues into the department tracking system.

Requirements

• Excellent organizational and prioritizing skills.
• Ability to work on simultaneous projects with diverse working groups.
• Strong communication skills to clearly convey ideas and thoughts.
• Ability to work with minimal supervision and be an effective team player.
• Ability to work in a fast-paced environment, handle multiple tasks, and prioritize work.
• Excellent listening skills and ability to address member concerns.
• Ability to work well with physicians and other medical professionals.
• Creative problem-solving skills to meet member needs.
• Ability to navigate multiple systems simultaneously.
• Proficiency in reading, writing, and understanding English.

Qualifications

• High School Diploma.
• Associate’s degree or equivalent work experience in the healthcare industry.
• Proficiency in Microsoft Office, with emphasis on Word and Excel.
• Strong knowledge of the healthcare industry and medical terminology.
• Insurance/managed care and claims processing background is a plus.
• Bilingual in English/Spanish is preferred.

Pay

Additional compensation for bilingual (English/Spanish) employees: $1,000 annually.

Schedule

9:00 AM to 5:00 PM.

Physical Demands

• Under 1/3 of the time: Standing, walking, climbing or balancing, stooping, kneeling, crouching, or crawling.
• Over 2/3 of the time: Talking or hearing.
• 100% of the time: Using hands.

Work Environment

• 1/3 to 2/3 of the time: Work near moving or mechanical parts, exposure to radiation, moderate noise.