Care Associate, Admin Support

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Job Description:

Location: We support US flexible working arrangements in the contiguous 48 states.  

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. 

The opportunity: As a Care Associate, Admin Support you are the first point of contact for the member and will be expected to represent PinnacleCare professionally and with a compassion that is the cornerstone of our culture. On this initial call you will verify eligibility and gather initial clinical and demographic information and warmly transfer the member to a Care Advisor while at all times providing exemplary customer service. While providing telephonic or Chat-based intake, you will also be expected to refer to account specific employee health benefits when appropriate. Most importantly, it will be your phone and/or presence that in many cases will sway a member to choose to move forward with PinnacleCare services or not. 

In addition to intake responsibilities, the Care Associate, Admin Support will spend most of their time providing support to the Care Advisor Team. You will be expected to complete tasks that include but are not limited to calling to schedule and gather information for member appointments, interviewing doctor’s offices to gather information on a specific physician, logging medical records requests into the CRM system, faxing medical records, and reviewing medical records for outcomes. This role specifically provides integrated partnership and support the Care Advisor who is the primary and ongoing contact between the member and PinnacleCare.

As PinnacleCare continues to advance with assisting technologies and automation, the primary role of Admin Support may further shift to Care Advisory Support, to the exclusion of Intake/Dispatch.

Hours: 10:00 AM EST – 7:00 PM EST

How you will contribute:

• Intake with Member (phone, web, email, Sun Life App, Third-Party Referral Portals)
  • Concierge-like phone etiquette with the intention to help the member in any way possible- from connecting them to a Care Advisor for PinnacleCare services to identifying an alternative employee health benefit to looking up a phone number if they called us erroneously
  • For Health360 App referrals, level 1 troubleshooting and expeditious dispatch to Care Advisors is a priority
  • Accurately add member and case to CRM (Salesforce)
  • Seek all opportunities to refer to other employee health benefits and PinnacleCare vendors

• Support and Teamwork Responsibilities.
  • At the direction of the Care Advisors, complete tasks to support their caseload; these may include:
    • Scheduling, rescheduling, or cancelling member appointments
    • Preliminary research on physician availability and insurance acceptance
    • Parse out specific member medical records for appointments, with final review by Care Advisor
    • Submit medical records requests to the Health Information team, after researching and populating contact information if necessary
    • Search for identified physicians from past PinnacleCare research efforts
    • Review medical records from scheduled appointments to determine outcomes, enter them in CRM
  • Participation in departmental meetings as appropriate, to provide innovative ideas and individual perspective when necessary
  • We provide a personable culture for our member and client interactions, as well as internal for our hybrid team collaboration. Therefore, our staff practices a video presence on meetings utilizing Zoom, Microsoft Teams, etc. as the setting and leadership requires.
  • Work effectively with Team Lead to ensure the best experience and outcomes for the member as well as to escalate service failures expeditiously  

• Utilization
  • Ability to capture accurate work hours in CRM on a daily basis, in r