Communities Member Care Advocate - Bilingual

Communities Care Coordinators, who are our most visible representatives of our mission to raise the standard of healthcare for everyone, are responsible for providing personalized service, via phone and chat, to Included Health members to connect them with high quality, culturally affirming providers; answer their healthcare benefits questions; initiate healthcare services on their behalf; and assist them with navigating the complexities of the healthcare system. 

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