JOB TITLE: Member Advocate: Masters Degree Required
SUBSIDIARY: Clinical Operations
GradStaff is currently recruiting for a Member Advocate with a large mental health Insurance Company located in the Twin Cities.
This position performs advanced Advocate duties which include: performing the role of mentor to new Member Advocates; delivery of training and orientation; and performing auditory function as assigned by supervisor. This position is also responsible for representing the company to all inbound callers. The Advocacy tasks of this position are varied and often complex in nature and include:
(1) Service and process explanation,
(2) Benefit, eligibility and complex claim interpretation,
(3) Screening and referral functions, services callers and
(4) Follow-up and service satisfaction,
(5) Participant Education needs based on participant’s presenting problem/issues, and
(6) Access to care function.
This position services callers and problem-solves independently. Incumbents will Utilize Telephony, Web, and internal materials to achieve first time resolution for callers.
1. Representing the company to all inbound callers
2. Registers participants in the intake system and opens case files.
3. Assists participants with requests for services.
4. Educate participants with respect to parameters of services and benefits design.
5. Educate participants with respect to presenting issues.
6. Provides participants with names and phone numbers of nearest providers according to contract, specialty, and/or geographic need and fosters introductions between parties.
7. Responsible for meeting Quality Indicators, 90% or greater each month.
8. Communicates pertinent data to providers when necessary, and alerts providers to expect participants’ calls.
9. Completes ad hoc provider searches as needed and writes authorizations to insure claims are paid correctly.
10. Assists and supports care managers in the handling of crisis calls.
11. Provides follow-up calls to participants to assess level of services, PCP Coordination, alert to available web services, and completes outcomes follow-ups.
12. Completes service tracking and initiates the Concern, Complaint, Grievance (CCG) process.
13. Assists less seasoned Member Advocates as necessary.
14. Participates in auditing cases and/or acts as a point person for specific accounts.
15. Demonstrates a complete awareness and understanding of the responsibilities and workflows of the various departments within the site.
16. Participates in staff meetings and in-service seminars.
17. Completes additional tasks and projects as assigned.
• Masters degree in mental health field or psychology/social work related field preferred (special note: this educational level may be required by some customers as designated specifically within their contracted services).
• Previous Customer Service Experience or related position.
• Superb interpersonal communication and leadership skills.
• Two years of experience in a mental health, social service, or insurance setting preferred.
• Effective listening and organizational skills, with the ability to manage multiple tasks.
• Ability to type effectively; strong PC skills/word processing experience.
• Experience in a service-focused environment.
• Ability to maintain a professional and positive imagine to internal and external customers.
• Ability to take on additional tasks as assigned and still is productive and supportive to the team and the incoming volume.
• Ability to delineate complex service and benefit issues.
• Ability to judge severity of crisis and delegate to care manager’s staff when necessary.
• Ability to maintain a high level of working knowledge about customers and products.
• Ability to match educational materials to participant needs.
• Ability to recognize and follow up on complicated service issues.
• Coordinate services efficiently in order to meet the needs of our customers.
• Strong support to the Member Advocate Team on a day-to-day basis.
• Make sound decisions, based on their own judgment experience. Make sound business decisions based on the needs of the caller to insure appropriate referrals to services.
• Work as a team member within a larger group
• Attendance at staff meetings in which clinical and administrative issues are discussed
OPPORTUNITIES FOR GROWTH:
• Company puts strong emphasis on internal career development
• Lead Member Advocate/Sr. Lead Member – responsible for new employee training
• Case Coordinator – acts as liaison between care management team and clients
• Care Manager (requires Master’s degree in Psychology)
• Account Reps, Wellness Coordinator Reps, Human Resources, and/or other positions wihin business structure
• Excellent opportunity for a Psychology graduate to use degree in a business setting
• Excellent benefits program, including medical, dental, vision, 401K and PTO
• Tuition reimbursement
Interested candidates can email their resume to firstname.lastname@example.org
GradStaff is an Equal Opportunity Employer and encourages applicants of all ages, experiences, and backgrounds to apply for open positions. GradStaff does not
discriminate on the basis an applicant’s age, race, color, creed, religion, national origin, sex, marital status, disability, sexual orientation, or status with regard to public assistance.
JOB TITLE: Member Advocate: Masters Degree Required