Healthcare Member Service Researcher
Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are supportive and friendly. Employees have room to grow, and many of Health Advocate's supervisors are promoted from within the company. Join our award winning team!
2023 Awards:
· National Customer Service Association All-Stars Award: Service Organization of the Year.
· Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year - Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner
BASIC FUNCTION
Responsible for researching and understand websites and reference materials regarding the healthcare system; provide information to nurses regarding providers, eldercare, nursing homes and other requested information; respond to member requests by providing specific resources and options; track cases and follow-up with members and providers in a timely manner
MAJOR JOB ACCOUNTABILITIES
Research Functions – Research and understand websites and reference materials regarding the healthcare system ensuring adherence to department and corporate policies and procedures
- Research and document request information (e.g., primary care physicians, dentists, etc.)
- Identify appropriate benefit plans for benefit offerings
- Provide information to advocates regarding providers, eldercare, nursing homes and other requested information
- Respond to member requests by providing specific resources and options
- Enter all required documentation into the system and ensure its accuracy
- Ensure research results are compiled in a user friendly format for members to review and respond
- Track cases and follow-up with members and providers in a timely manner
- Exercise exceptional customer service skills in an effort to optimize each contact with the member
- Ensure that calls are processed in strict adherence to established policies, procedures, quality standards as well as applicable federal laws and regulations
- Know and support approved departmental and corporate policies and procedures relating to benefit issues
- Ensure policies and procedures are in compliance with all applicable laws and regulations, including the privacy of employee health information in compliance with federal and state laws such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
Healthcare System Research Assistance - Assist in resolving routine research issues by identifying issue(s) and researching in a timely manner
*Follow research through until resolution
*Document all issues thoroughly maintaining department files or appropriate system
*Continuously evaluate the status of all work efforts, ensuring all tasks are prioritized to assist in providing timely and quality services
*Assist in monitoring issue trends, escalating such trends to supervisor to determine appropriate actions necessary to eliminate future occurrences and improve service levels
Team Interfaces/Customer Service - Establish and maintain a professional relationship with
internal/external customers, team members and department contacts
* Cooperate with team members to meet goals or to complete tasks
* Provide quality customer service that exceeds customer expectations and improves level of
service being provided
* Treat all internal/external customers, team members and department contacts with
dignity/respect
* Escalate to supervisor any situation outside the employee's control that could adversely impact
the services being provided
Mental and Physical Requirements
*This position will be exposed mainly to an indoor office environment and will be expected to work near or around computers, telephones, and printers
*The nature of the work in this position is sedentary and the incumbent will be sitting most of the time.
*Essential physical functions of the job include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware continuously throughout the work day
*Essential mental functions of this position include concentrating on tasks, reading information, and verbal/written communication to others continuously throughout the work day
Related Duties as Assigned - -
* The job description documents the general nature and level of work but is not intended to be a
comprehensive list of all activities, duties, and responsibilities required of job incumbents
* Consequently, job incumbents may be asked to perform other duties as required
* Also note, that reasonable accommodations may be made to enable individuals with disabilities
to perform the functions outlined above
* Please contact your local Employee Relations representative to request a review of any such accommodations
MINIMUM QUALIFICATIONS
Applicant for this job will be expected to meet the following minimum qualifications.
Education
* High School Diploma or G.E.D.
* Associates degree from an accredited college or university with major course work in business
administration, liberal arts, healthcare management, or a related field preferred.
Experience
* Minimum of one year healthcare experience preferred
Other
* Basic knowledge of MS Word, Excel, and Web Navigation required
* Must score acceptably on job related testing
* Ability to pass standardized interview
* Based on assignment may need to be bilingual in English, Spanish, etc.
A successful incumbent in the job will be able to demonstrate the following skills and abilities:
- Strong communication (verbal and written) skills and phone etiquette
- Ability to provide requested research or information to physicians’ offices, hospitals, insurance companies and nurses
- Highly effective listening skills
- Strong problems solving/issue resolution skills
- Excellent customer service and customer resolution skills
- Organizational and administrative skills including follow-up on issues and the ability to multitask.
- Ability to work in a team environment
Company Overview
Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need.
Learn more
Health Advocate https://www.healthadvocate.com/site/
Facebook https://www.facebook.com/healthadvocateinc/
Video https://vimeo.com/386733264/eb447da080
Awards:
2023:
- National Customer Service Association All-Stars Award: Service Organization of the Year.
- Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner
2022:
- Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner
- Excellence in Customer Service Awards: Organization of the Year (Small)
- Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)
2021:
- Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Silver Winner
- Stevie® Awards for Sales & Customer Service: Most Valuable Response by a Customer Service Team (COVID-19). Bronze Winner
- Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver)
2020:
- National Customer Service Association All-Stars Award: Organizations of 100 or Greater, Runner-Up
- Communicator Award of Distinction: October 2019 Broker News
- MarCom Awards: Gold, COVID Staycation Ideas brochure
- MarCom Awards: Platinum, 2021 Well-being Calendar
- Best in Biz Awards: Most Customer-Friendly Company of the Year - Medium category (Silver)
Health Advocate is an Equal Opportunity Employer that does not discriminate on the basis of race, color, sex, age, religion, national origin, citizenship status, military service and veteran status, physical or mental disability, or any other factor not related to job requirements. We respect and value diversity, and are committed to the principles of Equal Employment Opportunity.