Member Advocate

Position Code: 3073

Department:  Customer Care
Location: Columbus, Ohio
Immediate Supervisor:  Member Advocate Supervisor
Status: Non-Exempt
Posted: July 07 2017

Essential Functions of Job:

• Provide exceptional customer care through taking/making inbound/outbound calls and inquiries from members, providers and other client representatives in regards to benefits, claims, eligibility and provider search. • Establish and maintain professional rapport with members, clients and providers • Coordinate activities between patients, providers, PBM’s and other entities related to members care. • Work with various departments to research claims and resolve outstanding issues • Utilize Plan Analytics and HealthSCOPE’s system to accurately document and identify data relevant to the members care • Work with members to help them understand their benefits and various wellness programs available to them through their plan • Assist members with outstanding medical claims and balance due statements • Help members locate in-network providers • Perform outreach initiatives to members on behalf of client to inform them of new programs and benefits available to them, as well as, activities they may need to complete to remain compliant with the plan • Identify and escalate issues and concerns related to member inquiries • Other duties as assigned • Ability to report to the office

Qualifications:

• High school diploma or equivalent • Effective organizational and prioritization skills • Excellent oral, listening and written communication skills • Basic knowledge of Microsoft Office software applications (Word, Excel, Outlook, Access) • Ability to work in a fast paced multi-tasking environment • Strong interpersonal skills with ability to function as a positive team member • Working knowledge of CPT-4 coding, ICD9 and medical terminology a plus • Detailed oriented • 2-3 years experience in the medical field, customer service and/or claims processing background preferred • Ability to understand and speak Spanish a plus

 

The Company considers applicants without regard to race, color, national origin, sex, religion, mental or physical disability, marital status, age 40 years and over, sexual orientation or gender identity, veteran's status, or other characteristic protected by applicable law.

Applications for this vacancy will be received for 3 working days after the Posted date from Employees of HealthSCOPE Benefits with more than one year of service.

Applications for this vacancy will be received for 10 working days after the Posted date from External Applicants.