Job Description

Expert Advisor III: Member Services & Health Plan Navigation

We are seeking a highly experienced and dedicated Expert Advisor III to join our team, which provides specialized support for large corporate clients. This is a crucial role focused on delivering a personalized and high-touch experience for members with unique health plan needs.

Key Responsibilities

As an Expert Advisor, you will act as a primary point of contact and navigator for our members. Your responsibilities include:

• New Member Engagement: Serving as an ambassador for new members, helping them understand their plan, its value, and how to effectively use their benefits. This includes walking them through online resources and assisting them in finding doctors and facilities.
• Complex Issue Resolution: Proactively identifying and resolving complex issues related to healthcare delivery or financial barriers. You will serve as a patient advocate , working with cross-functional partners to drive process improvements and ensure a seamless experience.
• Provider & Service Navigation: Conducting provider searches, scheduling appointments, and helping members understand the distinction between in-network and out-of-network services, referrals, and claims submission procedures.
• Customer Relationship Management: Providing one-contact resolution for escalated concerns and applying considerable discretion to formulate effective solutions. You'll be responsible for meeting the needs of high-touch groups and challenging market segments.
• Documentation and Reporting: Maintaining detailed documentation, tracking issues, and summarizing information to provide recommendations to management. You will also identify trends and systematic issues, offering consultation on process improvement opportunities.

Qualifications

• Experience: A minimum of seven (7) years of experience in a customer service, health care, or health insurance-related field is required. Previous experience in a healthcare call center, especially with our organization, is highly desired.
• Skills: You must possess outstanding written and oral communication skills, a strong customer service focus, and the ability to work independently with minimal supervision. Strong problem-solving skills, resourcefulness, and a demonstrated ability to manage and execute complex, multidisciplinary issues are essential.
• Education: A High School Diploma or GED is required.
• Familiarity: Knowledge of medical terminology, benefit interpretation, and authorization/precertification of services is a significant plus.

This is a fully remote position, and the Expert Advisor will be an integral part of a small team that provides a unique service model for our valued clients. We are looking for forward-thinking individuals dedicated to helping members achieve the highest quality of care.

Job Tags

Similar Jobs