Communities Member Care Advocate - Bilingual

Responsibilities:

• Answers in-bound telephone calls and virtual chats in a Contact Center environment from members to provide administrative, financial, and clinical support with empathy and respect.
• Own the member's health care journey from start to finish by answering member calls; communicating with members via Phone and Chat; advocating with insurance companies and community healthcare providers to resolve medical billing problems; and researching available benefits in order to identify the optimal resolution for the member.
• Clearly, timely, and comprehensively collect, capture and document information gained in member interactions, including, but not limited to, demographic and insurance information.
• Contribute to the provider directory by researching and contacting providers to ask a series of questions to collect comprehensive data about their practice and to evaluate if the provider is high-quality and provides culturally competent & affirming care.
• Serves as the liaison between Included Health, its clinicians, and members by supporting and promoting clinical services to members.
• Follows set processes, procedures, and workflows in assisting members with:
• Advocates and navigates member, including finding new providers for members and assisting with locating resources and addressing Social Determinants of Health
• Educate members on their benefits coverage, including, but not limited to, when to consider utilizing their benefits, and how to leverage their benefits
• Triages/supports claims and billing inquiries, prior authorizations, and other support questions.
• Connects members to IH clinical services, including virtual care services, second opinions, etc.
• Upholds IH's mission of raising "The Standard of Healthcare for Everyone"
• Embodies the IH Values and fully understands its services, including:
• Drive strong outcomes in the areas of Member Experience, Scale and Value.
• Collaborates with other Care Coordinators, Leadership, and other departments on specific member healthcare journeys.

Qualifications:

• Exceptional business writing skills in English and Spanish, including proficiency in spelling and grammar, and excellent verbal skills (you will need to explain our services with confidence and a friendly telephone demeanor).
• Proficiency with Google Apps, Apple Products, and Customer Relationship Management Software is preferred.
• Familiarity and comfortability with Voice-over-IP (VoIP) phone systems (e.g. CXOne) and communicating through such systems for a majority of the work day.
• Bachelor's degree or 2+ years of relevant work experience in healthcare, advocacy, or benefits/insurance organization is highly preferred.
• Excellent customer service skills.
• Exceptional critical thinking and problem-solving skills to assess and resolve complex healthcare situations.
• Successful at handling confidentiality, security, and HIPAA guidelines and regulations.

Physical/Cognitive Requirements:

• Ability to work shifts of at least 8 hours, 5 days per week.
• Ability to work from a dedicated space that is distraction-free, sufficiently HIPAA compliant, and has a secure, high-speed, hardwired internet connection
• Ability to operate in a fast-paced, high-intensity work environment where you will have multiple tasks and priorities to manage in an ever-changing landscape.
• Ability to remain in a stationary position for prolonged periods while utilizing a computer to perform all work duties.
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment.
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required.
• Ability to interact with leadership, employees, and members in an appropriate and respectful manner.
• Maintains composure during moments of stress, maintains a helpful disposition at all times, and leverages de-escalation skills and techniques when necessary.
• Ability to exercise good judgment, work effectively under time constraints, prioritize work, multi-task, and adapt to changing work demands.