Research Analyst- Family Health Advocate

Job Description:

Job Summary: 

The role of the Family Health Advocate-Research Analyst is an exciting and integral role in providing meaningful advocacy support to members and their families through personalized resource and referral facilitation, issue resolution and healthcare navigation. In this role you will provide research to support and resolve cases originating from our Family Health Advocates that require additional follow up. Case follow-ups include but are not limited to the coordination of benefits, health claim appeals, re-submissions and/or re-coding, EOB reviews and researching provider availability and scheduling appointments.   

Essential Job Functions: 

• Support follow up needs from Family Health Advocate calls for the following: 

• Research and resolution to eligibility, claims issues, ID card issues, grievances/appeals, utilization management (UM) status including but not limited to medical, dental, and vision plans 

• Provider search (PCP, specialty, and facility), focused on healthcare cost and quality, and present premier provider options, including but not limited to medical, dental, and vision plans 

• Support for spending accounts, pharmacy, and disability. 

• Aid with ordering durable medical equipment (DME)  

• Community resource search 

• Coordinate issue resolution with providers, payers or 3rd parties for:  

• Claims adjustments  

• Grievances and appeals submissions  

• Utilization management intake or status  

• Complex pharmacy inquiries  

• Complex spending account inquiries  

• Appointment availability 

• Primary duties include but are not limited to:  

• Research and documentation of issue resolutions. 

• Timely management of assigned queue tasks requiring research and resolution 

• Work closely with assigned Family Health Advocates to ensure timely resolution and follow up of tasks  

Specific Skills/ Attributes: 

• Excellent multi-channel communication and problem-solving skills 

• Ability to communicate effectively in both voice and chat channels, including critical thinking skills, effective typing, grammar, and spelling skills. 

• Proficient in general office tool use and navigation (i.e., Microsoft) 

Qualifications: 

• High school / GED diploma 

• 2-yr associates degree in healthcare/health sciences OR equivalent experience in healthcare, preferably with research and resolving benefits and claims, OR held one or more of the following positions: 

• Health Guide/Advocate/Navigator  

• Claims Specialist/Processor 

• Medical Assistant 

• Medical Secretary/Clinic Manager 

• Medical Coder 

• Customer service experience within a healthcare contact center, provider office, or healthcare institution  

• Experience in successful resolution of high level/sensitive customer service issues.<