Health Advocate, Inc. is a US national health advocacy, patient advocacy, and assistance company, serving more than 12,800 clients and 40+ million people and offering a spectrum of services to help employers, employees and consumers navigate the healthcare system and facilitate members’ interactions with insurers and providers. The privately held company was founded in 2001 by former Aetna executives and is headquartered in Plymouth Meeting, Pennsylvania. Read employee reviews, salaries, and benefits here
MAJOR JOB ACCOUNTABILITIES
Service Functions – Assist members in navigating the healthcare system by answering a variety of incoming calls and responding to members healthcare questions and issues while ensuring adherence to department and corporate policies and procedures
• Connect with members by phone and quickly develop a rapport to help the individual to navigate their benefit choices and options
• Determine appropriate resolution to assist members based on their needs
• Transfer calls outside the scope of responsibility to appropriate internal or external resource
• Process calls in the specific queue (e.g., triage, biometric, etc.) based on assignment
• Verify/Collect appropriate demographic information and update inappropriate system
• Follow-up with members, providers, insurance carriers, and other vendors ensuring adherence to established policies
• 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
MINIMUM QUALIFICATIONS
An applicant for this job will be expected to meet the following minimum qualifications.
Education
* Associate's degree from an accredited college or university with major course work in fitness,
public health, healthcare management, or a related field required.
*Bachelor's degree from an accredited college or university with major course work in fitness,
public health, healthcare management, or a related field is preferred.
Equivalent work experience in a similar position may be substituted for educational
requirements.
Experience
*Minimum of 2 year's customer-facing benefit administration, healthcare, nursing, dietary,
fitness or a related experience is required
Other
*Basic knowledge of Microsoft Word, Excel, and Outlook required
*Based on the program may need to be bilingual in English, Spanish, etc.
*Applicable fitness, training, dietary, or other related certifications preferred
A successful incumbent in the job will be able to demonstrate the following skills and abilities:
*Strong communication skills and phone etiquette
*Strong ability to explain complex issues to members in simple, understandable terms
*Highly effective listening skills
*Strong problems solving/issue resolution skills
*Excellent customer service and customer resolution skills
*Strong organizational and administrative skills
*Ability to work in a team environment.
Position Overview At Health Advocate, we are committed to providing our customers with expertise and services that improve the health, well-being, and productivity of their employees. We are looking for the right person to: work with medical providers to negotiate balances outstanding on members' claims. The appropriate candidate would be responsible for managing multiple claims cases, interfacing with internal staff and external providers to understand and negotiate claims balances. The appropriate candidate will follow up to ensure all aspects of the negotiation are documented and processed for member satisfaction. Essential Job Functions • Handles Member calls & cases for claims fee negotiation • Negotiates Consumer/Member Medical Claims with Healthcare Providers • Send and Acknowledge receipt of Contracts from Consumers/Members and Providers • Tracks all Settlements • Reports Settlement results within the system and Statistics to Management • Works with other Health Advocate units, including training when requested • Works with product development VP to refine the process and improve the Consumer/Member Settlement product • Supports Sales & Marketing as SME, including participation in meetings with Current and Prospective Customers • Provide benefit and claims consultation and support when appropriate to all internal departments. Requirements • Claims or Call center experience preferred • Bachelor's Degree or applicable work experience. • Effective communication skills to interact with members, physicians, and insurance carrier representatives, with an emphasis on the ability to communicate both verbally and in writing. • Assertive, self-confident, and resilient. • Basic computer skills. • Ability to search and identify resources through the internet. • Demonstrated ability to communicate concepts, strategies, and plans in terminology understood by business professionals. • Ability to interpret Explanation of Benefits (EOBs). • Familiarity with various types of health insurance coverage, coordination of benefits, and UCR fees.
Equal Opportunity Employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race. color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age, pregnancy, genetic information, or any other consideration prohibited by law or contract.
Job Responsibilities:
• Responsible for the administrative functions and supervision of an operations unit. This includes backlog and quality management for a team of Operations/Customer Service associates
• Provide organization, direction, and staffing for all assigned service calls and caseload assignments to ensure all calls are answered in accordance with Health Advocate’s policies and procedures.
• Monitor calls and audit case files daily to ensure the proper target resolution is identified and that, if possible, the case is closed at or near the target resolution.
• Ensure assigned staff members meet or exceed the standards, results, and responsibilities of their respective positions.
• Coach, mentor, and evaluate the performance of an assigned team.
• Assist in the selection, counseling, and discipline of all staff on the team.
• Provide oversight and direction to staff for assigned cases.
• Responsible for problem-solving issues and coordinating efforts with internal departments and subject matter experts.
• Provide healthcare benefit and claims consultation and support when appropriate to all internal departments.
• Routinely evaluate and monitor service calls and case management procedures to recommend any necessary changes to the Operations Manager.
• 11. Escalate cases through the appropriate channels in accordance with Health Advocate’s policies and procedures.
Qualifications
• Call center experience preferred
• Bachelor's Degree or applicable work experience.
• Management or supervisory experience in healthcare benefits or claims processing.
• Strong leadership skills and the ability to build effective teams.
• Effective communication skills to interact with members, physicians, and insurance carrier representatives, with an emphasis on the ability to communicate both verbally and in writing.
• Assertive, self-confident, and resilient.
• Basic computer skills.
• Ability to search and identify resources through the internet.
• Demonstrated ability to communicate concepts, strategies and plans in terminology understood by business professionals.
• Ability to interpret Explanation of Benefits (EOBs).
• Familiarity with various types of health insurance coverage, coordination of benefits, and UCR fees.
Health Advocate is looking for Bilingual Customer Care Associates to join our team.
A Customer Care Associate in an important position providing guidance and direction to our members regarding the health care system. If you have previous customer service experience, this role may be a good fit for applying your current member service skills. This position also provides training in health-related, issues to build a career.
Health Advocate offers a comprehensive training program to develop the knowledge you need to be successful in assisting members.
We offer Great Benefits! The benefits package for this position includes a very generous Paid Time Off (PTO), paid holiday policy, tuition reimbursement and a 401(k) with a match.
Health Advocate has an Onsite fitness facility, yoga classes, Employee Assistance Programs, wellness programs, and employee activities to support employees with various goals.
Hours of Operation: Monday through Friday
Various shifts available
Job Summary:
Answer a variety of incoming calls from members regarding their healthcare questions and other inquiries the member may have
Build rapport with callers using a friendly, courteous, and professional manner
Verify/Collect demographics and update systems as necessary
Determine and execute the best resolution to assist the member based on their needs or requests
Connect members to appropriate area(s) both internally and externally
Manage tasks with timely follow-up per policies, which involve interaction with members, providers, insurance carriers, and other vendors
Perform other duties and projects as assigned by management
Minimum Requirements:
High School Degree or GED required/ Associate’s degree with major course work in business administration, liberal arts, public health, healthcare management, or a related field preferred
Customer Service in a telephone environment preferred
Strong communication skills and phone etiquette
Strong problem solving/issues resolution/multitasking skills
Fluent in Spanish
Health Advocate is looking for Research Associates to join our growing team.
Research associates access a variety of tools to find healthcare providers and health plan options for members. Health Advocate provides a comprehensive training program to teach health plans and health provider information. The position works to provide information to nurses regarding providers, eldercare, nursing homes, and other requested information. This position is also a key resource for benefit personnel to find health plans for members If you have previous customer service experience, this role may be a good fit for applying your current knowledge and starting a career in health benefits administration.
We offer Great Benefits! The benefits package for this position includes a very generous Paid Time Off (PTO), paid holiday policy, tuition reimbursement, Programs, and a 401(k) with a match.
Health Advocate has an Onsite fitness facility, yoga classes, Employee Assistance Program, wellness programs, and employee activities to support employees with various goals.
As a Product Manager, you will report to the Director of Product Strategy. You will own Health Advocate’s Well-being digital solutions through the entire product development lifecycle (from discovery to delivery). Your charter is to change healthcare by creating a more navigable and "next best action" type of experience where consumers/members can find the information and tools they need within only a few clicks and present relevant health-related recommendations personalized to them and their family members.
You'll work with an array of internal and external partners, garnering their perspectives throughout your roadmap creation and evolution, but also bring them along to your product vision using data, insights, and aligning to our business goals.
You Will:
Take a major role in co-creating and defining product vision, strategy, and objectives.
Work with Engineering, Design, Marketing, Analytics, and other Product Managers to plan, build and launch high-quality product experiences and relentlessly optimize them.
Write great epics, user stories, and acceptance criteria to guide the development
Understand design and engineering tradeoffs and make the right call for the product.
Serve as a point person for your initiatives, aligning key internal & external stakeholders on prioritization and resourcing
Develop, prioritize and manage product backlogs, in partnership with engineering
Act as the Product Owner in an agile SCRUM environment
Write release notes and train internal stakeholders on new features.
Drive continuous process improvement by leading the development, implementation, and maintenance of standardized tools, templates, and processes across the enterprise.
Stay on top of all relevant health care and consumer technology trends, competitors, and market offerings
You Have:
3-5 years of experience building software products with 2+ years on consumer-facing software products or applications
Experience with delivering new and engaging experiences that customers love that are informed by customer data from various sources
Experience in health-related solutions
Experience defining and measuring engagement metrics
Experience with Scrum and agile software development processes
Job Description
Essential Job Functions
Receive and respond to intake calls
Explains the role of EAP and confidentiality
Obtains and records intake case information in Care Management System
Assess crisis situation and take appropriate action
Provides referral services to EAP clients
Provides information and schedules clients requesting phone services
Provides members with an appropriate referral based on clinical needs, provider expertise, location, insurance coverage, and affordability
Facilitates referral process and contacts service providers or subcontracted EAP affiliates
Follow up with client and/or service provider /affiliate as required per Standard Operating Procedure
Documents all contacts with clients and pertinent others accurately, completely, and concisely
Facilitates connection or referral to other available services such as legal/financial consultation, work-life resources, or other solutions that may be available to Health Advocate members
Provide other Employee Assistance services as assigned including case management of special needs, high risk, and company –initiated referrals
Provide telephonic services including assessment, crisis interventioncompany–initiated, consultation with Human Resources or other client company leadership, and brief support to members
Collaborates with Care Managers and others to ensure compliance with SOP, to provide excellent member service and experience, and to support professional operations and environment within the EA division
Participate in regular supervision and consultation as needed/appropriate to any case
Develop and maintain familiarity with Health Advocate EAP Standard Operating Procedures as demonstrated by the delivery of service and performance of duties
Maintain reliable attendance and timely arrival being ready to work as scheduled
Maintain licenses in good standing, and related credentials if applicable
Miscellaneous duties as assigned by Director or Executive management.
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