[Hiring] Member Services Advocate @Point32Health

Role Description

Under the general direction of the Service Center Supervisor, the Member Services Advocate provides exceptional customer service, navigating the complexities of the healthcare system, addressing inquiries, resolving issues, and ensuring members have a positive experience with Point32Health.

• Handle inbound calls from members with professionalism and attentiveness, addressing inquiries related to health insurance benefits, coverage, claims, and eligibility.
• Support and advocate for members to ensure that they receive the care/support needed.
• Provide education and guidance to members about their Point32Health benefits and take ownership of each call to ensure that issues are resolved promptly and accurately.
• Assist members in understanding and accessing their benefits and educate members on how to use self-service tools, delivering proactive/anticipatory service.
• Record call details and member interactions in the system accurately, ensuring that all relevant information is documented for future reference and reporting, ensuring HIPAA, State, and Federal regulations and confidentiality standards are met.
• Work collaboratively with other team members and departments to address complex issues and ensure a seamless member experience.
• As a brand ambassador for Point32Health, go above and beyond to ensure member satisfaction, proactively identifying and addressing needs and concerns.
• Represent the voice of the customer by contributing to continuous improvement initiatives and providing feedback on member interactions and suggesting process enhancements.
• Adhere to assigned schedules to ensure appropriate phone queue coverage & meet or exceed department established key performance indicators.
• Execute outbound calls to improve the member experience and assist in member retention.
• Ensure all interactions are HIPAA compliant and adhere to state and federal regulations.
• Other duties as assigned.

Qualifications

• Required: Associate degree or equivalent work experience.
• Preferred: Bachelor’s degree or equivalent work experience.
• Required: 0-2 years of relevant experience.
• Preferred: Customer service experience in health care, call center, or corporate office.
• Knowledge of medical terminology.
• Prior experience training and working in a virtual/remote setting.

Requirements

• Demonstrated ability to provide exceptional service, including active listening, empathy, and clear communication with members.
• Ability to put yourself in someone else’s shoes and demonstrate compassion.
• Strong understanding of health insurance products, policies, and industry regulations, or the ability to quickly learn and apply new information.
• Adept at identifying issues, analyzing information, and providing effective solutions in a timely manner.
• Excellent verbal and written communication skills, with the ability to convey complex information clearly and professionally.
• High level of accuracy in handling member information, processing requests, and documenting interactions.
• Capable of managing multiple tasks simultaneously while maintaining focus and efficiency.
• Comfortable using computer systems, CRM software, and other relevant technology to manage member interactions and data.
• Ability to adjust to changing priorities and new processes in a dynamic work environment.
• Strong people skills with the ability to work effectively with team members and contribute to a positive work atmosphere.
• Skilled in managing and resolving conflicts and complaints with professionalism and patience.

Benefits

• Medical, dental, and vision coverage.
• Retirement plans.
• Paid time off.
• Employer-paid life and disability insurance with additional buy-up coverage options.
• Tuition program.
• Well-being benefits.
• Full suite of benefits to support career development, individual & family health, and financial health.