Facebook pixel

Member Advocate - Overnight Shift
Posted on 6/10/2022
INACTIVE
Locations
Remote
Experience Level
Entry
Junior
Mid
Senior
Expert
Desired Skills
Customer Service
Management
Writing
Requirements
  • Excellent customer service skills - our members are top priority and we are their advocates
  • Ability to multi-task and remain flexible in an ever changing environment
  • Excellent verbal skills are essential as you'll need to explain our services with confidence, speak clearly, confidently, and have a friendly phone demeanor with the ability to anticipate needs
  • Effective time management, demonstrating high organization and attention to detail with tasks and deadlines
  • Exceptional business writing skills, including accurate spelling and grammar. Not only will you talk to people on the phone, you'll communicate with members and doctors in writing as well
  • Proficiency with technology; experience with Google apps, Apple products, and customer relationship management software a plus
  • Ability to independently manage one's own workload while maintaining quality targets, department metrics, and exceeding member expectations
  • Ability to work interdependently with resourcefulness when faced with challenges and opportunities to collaborate
  • Demonstrated ability to think critically and problem solve complex situations
  • Be empathetic. You'll work with members and their families who are going through challenging times
  • Ability to keep perspective, be empathetic, be efficient and reassure them that you can help is critical to the role
  • A sense of humor. We work hard. So we like to laugh a lot, too
  • Ability to work from a home office if needed
  • Acknowledges member's rights on confidentiality issues, maintains member confidentiality at all times, and follows HIPAA guidelines and regulations
  • Proactively continues to educate self on providing quality care and improving professional skills
  • Office and/or customer service experience required
  • Familiarity with phone systems and being comfortable with communicating on the phones majority of the day
  • Previous experience with Mac products and Google platforms highly preferred
  • Credentialed or Licensed in medically related field preferred (i.e., Medical Assistant, Pharmacy Technician, Case Manager, Social Worker)
  • Bachelor's degree or 5 years of relevant experience in healthcare or benefits/insurance organization is preferred, but not required
  • Familiarity with motivational interviewing or coaching desired
  • Knowledge about and connections to community health care and social welfare resources is preferred
Responsibilities
  • Answer inbound calls and chats from members, providers, and vendors on our dedicated lines, treating each with empathy and respect
  • Verify member's account information including insurance and benefits navigation
  • Conduct provider matching to ensure members have in network (INN) providers and are of high quality
  • Complete related administrative tasks such as submitting letters to be sent to members and local providers, follow up calls to provider offices and members to confirm appointments, obtaining signed medical releases, faxing medical releases and clinical summaries to provider offices
  • Complete outbound related projects to high opportunity members
  • Coordinate care through team huddles as part of an interdisciplinary team to advocate on behalf of patients, care team, family/caregiver(s), payers, and community resources using care plan development and adherence
  • Consult with members and discuss their health goals and challenges in order to connect them to quality programs leading toward healthier outcomes, utilizing motivational interviewing/health coaching techniques
  • Attend ongoing training and courses to keep skills current with new developments in healthcare
  • Comply with organizational guidelines and health care laws and regulations
  • Enhance clinical outcomes for members by promoting timely access to appropriate care, increase utilization of preventative care and reducing emergency room utilization and hospital readmissions
Grand Rounds

501-1,000 employees

Personal care platform
Company mission
Grand Rounds is on a mission to raise the standard of healthcare for everyone, everywhere. The Grand Rounds team goes above and beyond to connect and guide people to the highest quality healthcare available for themselves and their loved ones.
Benefits
  • Along with comprehensive medical, dental and vision plans; all employee spouses and children can access Included Health services at no cost. For time off, take it when you need it with our unaccrued discretionary time off for all exempt employees.
Company Values
  • We put the member first
  • We're here for outcomes
  • We seek diverse perspectives
  • We value change
  • We lead the way