Member Services Advocate

About the role

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health . Job Summary Under the general direction of the Service Center Supervisor, the Member Services Advocate provides exceptional customer service, navigating the complexities of the healthcare system, dressing inquiries, resolving issues and ensuring members have a positive experience with Point 32 Health. The Member Service Advocate is a member champion to resolve issues internally with a wide variety of departments and interacting externally with providers, employers, brokers and provider billing offices to assist with issue resolution. A candidate should be proficient in working in multiple systems at once while doing real-time analysis of data and documentation to resolve member inquiries. Training Hours: 8:30 AM - 5:00 PM EST, M - F. Must have 100% attendance during training. Working as a Member Advocate provides you with hands-on experience to grow your career with Point32Health. With demonstrated initiative and strong performance, you will gain exposure across a multitude of functions providing you with opportunities for advancement. A Member Services Advocate can grow not only within the department but also throughout Point32Health. Job Description Inbound Call Management - Handle inbound calls from members with professionalism and attentiveness, addressing inquiries related to health insurance benefits, coverage, claims and eligibility. Health Care System Navigation - support and advocate for members to ensure that they receive the care/support needed Problem Resolution - 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. Follow up with members as needed to ensure complete resolution. Member Engagement - Assist members in understanding and accessing theit benefits and educate members on how to use self service tools, deliver proactive/anticpatory service Documentation and Reporting- Record call details and member interactions in the system accurately, ensuring that all relevant information is documented for future reference and reporting ensuring HIPPA, State and Federal regulations and confidentiality standards are met. Team Collaboration - Work collaboratively with other team members and departments to address complex issues and ensure a seamless member experience. Member Experience- As a brand ambassador for Point32Health, go above and beyond to ensure member satisfaction, proactively identifying and addressing needs and concerns. Continuous Improvement- Represent the voice of the customer by contributing to continuous improvement initiatives and providing feedback on member interactions and suggesting process enhancements. Metrics & Goals- Adhere to assigned schedules to ensure appropriate phone queue coverage & meet or exceed department established key performance indicators Member Retention & Outbound Campaigns- Execute outbound calls to improve the member experience and assist in member retention Compliance and Policy Adherence- Ensure all interactions are HIPAA compliant and adhere to state and federal regulations Other duties as assigned. Qualifications - what you need to perform the job. Education, Certification and Licensure Required: Associate degree or equivalent work experience Preferred: Bachelor's degree or equivalent work experience preferred. Experience (minimum years required) : 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. Skill Requirements Customer Service Expertise- Demonstrated ability to provide exceptional service, including active listening, empathy, and clear communication with members. Empathy- Ability to put yourself in someone else's shoes and demonstrate compassion. Product Knowledge - Strong understanding of health insurance products, policies, and industry regulations, or the ability t