Health Advocacy Concierge
This position is responsible for being a compassionate and dedicated advocate for the member to demonstrate a concierge attitude when assisting members with maximizing their benefits, navigating the healthcare system and reaching their optimal health. Responsible for providing guidance and answering questions from members about their benefits and medical claims, as well as educating members about health and wellness programs. Assisting members in assessing tools available to help guide and inform decision-making about complex matters related to their health and wellbeing. Emphasize adherence to the member's personal plan of care and help to facilitate the member's selection and access to in-network healthcare providers in pursuit of that plan. Collaborate with providers, families, and patients to ensure member and treating provider needs are met. The incumbent is a subject matter expert and may handle projects and assist with training others.
As a subject matter expert, support inbound calls from members with a concierge attitude helping to anticipate and coordinate any related activities that are needed to bring that member's issue to resolution and to optimize the member's health and wellbeing. This position is responsible for the following functions:
- Build rapport and trust with each caller to maximize the opportunity to encourage member's compliance with chronic and preventive health care services and, if appropriate, initiate referrals to Primary Nurse Program and/or other programs.
- Facilitate the member's selection and consumer oriented evaluation of in-network healthcare providers when discussing planned health care services.
- Process information from member and/or the treating provider to determine needs/wants and ensure the member's questions have been anticipated and addressed.
- Conduct research with internal and external parties and bring those findings back to the caller in a timely basis.
- May conduct outbound calls.
- Encourage and where appropriate collaborate with the member's treating providers and family members. Ensure communication is open and information is shared in compliance with HIPAA.
- Assist caller by raising awareness of tools and resources designed to help with decision-making around complex health issues, e.g. coordinate effective medical management. Where appropriate Advocate may assist member with accessing and navigating available tools.
- Exhibit flexibility when dealing with member's needs including when there are deviations of normal practices, procedures or benefit structures.
- All verbal and written communications are thoughtful, professional and support the goals and objectives of the advocacy program.
- Adhere to system generated work schedule by Workforce Management to maximize customer service availability based on business needs.
- May handle special projects and/or assist with training others.
Required Job Qualifications:
- Associate degree and 3 years of concierge oriented customer service experience OR Bachelor degree and 2 years of concierge oriented customer service experience OR 4 years of concierge oriented customer service experience.
- Knowledge of HCSC customer service systems, processes, and products of the operational area.
- Experience emphasizing plan of care, assisting customers to select in-network providers, and train customers on tools.
- Knowledge of medical terminology.
- Experience building trust and providing concierge level of service.
- Clear and concise verbal and written communication skills, including motivational interviewing to interact with the members and physicians.
- Attention to detail and strong documentation skills.
- Web and PC proficiency.
Preferred Job Qualifications:
- Associate degree in Health Science or Health Studies or Bachelor degree.
- 3 years of concierge oriented customer service experience in an insurance environment.
- Clinical or social work expertise.
- Experience in coordinating medical services.
- Knowledge with health benefit plans and the insurance industry.
Additional Responsibilities Required by All HCSC Employees:
- Act with integrity and maintain a respectful, professional manner in all interactions with co-workers, management, customers and other business contacts
- Comply with HIPAA, the Code of Business Ethics & Conduct, our Diversity & Inclusion Principles, and other applicable corporate and departmental policies
- Maintain complete confidentiality in all matters of company business
- Maintain communication with management regarding developments within areas of assigned responsibilities, and perform special projects as required or requested
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Claims & Customer Service Job Type Full-Time Regular Location TX - Richardson
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