MEMBER SERVICES REPRESENTATIVE - HOAG CLINIC ENGAGEMENT SERVICE

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JOB DESCRIPTION

The Member Advocate Level serves our patients, members, and providers to facilitate the delivery of healthcare acting as an ambassador on behalf of the member.  In a call center work-environment, the Member Advocate deploys empathy, problem-solving skills and perseverance to exceed the expectations of its customers and partners. Member Advocates respond to all member and provider inquiries delivering top-caliber concierge service through multiple communication channels. With the assistance of data and technology, member advocates guide members through scheduling, benefits and care services to ensure a high value and personalized experience. This role is central to ensure a uniquely Hoag experience and a successful journey through the healthcare system. Member advocates operate in a continual learning experience empowered to self-correct and influence process improvement and technology improvement.

 

LEVEL II AND ABOVE

Member Advocate Level II develops a specialized expertise in a specific domain (Health Plan benefits, Provider Disputes, Professional chat etiquette guidelines, etc.).  The Level II advocate has a high proficiency to address complex issues with claims and referrals. The Level II advocate will also perform outreach calls to assist with wellness activities.

 

LEVEL III

Member Advocate Level III is a mentor on the team that leads aspects of the training function, is a subject matter expert in a variety of knowledge sets, and effectively handles service recovery functions, and is a change agent for service delivery and process improvement activities.

 

 

ESSENTIAL FUNCTIONS:

*Respond to the inbound member and provider and healthcare entity communications (call, text, email, chat, etc.) adhering to designated protocols and service responses while providing exceptional customer service *Assist in cases requiring additional non-clinical follow-up and care coordination, including, but not limited to: enrollment and eligibility, scheduling appointments, plan benefits, claims, referrals  provider network inquiries, care management program assistance, and obtaining ancillary results and medical records *Communicate and collaborate with interdisciplinary teams; when needed ensure effective soft transfers with utilization management, clinical care, and wellness teams *Accurately collects and documents the appropriate level of information to facilitate resolution and identify trends *Function as a detective to find creative solutions to difficult problems *Ensure problem resolution or smoothly transition to a higher level advocate or manager when appropriate *Participate in process improvement activities by openly sharing thoughts, ideas and constructive feedback to technical, Hoag experience, and management steams *Recognizes the presence of patient issues that may require immediate clinical assessment or action, based on BLS training and the Red Flag List, and notifies clinical staff *May assemble and send new patient packets, registration packets, and history/physical forms prior to scheduled appointments. *Responds appropriately to inquiries and complaints. Can troubleshoot and problem solve independently as situations occur *Ensures adherence to daily operating metrics systems *Other duties and projects as assigned

LEVEL II AND ABOVE

*Outreach to members and patients to facilitate onboarding; persuade participation in wellness and health promotion activities such as ensuring effective transitions of care; arranging for completion of gaps in care, scheduling annual wellness visit; and to communicate authorization approvals and denials within required time frames *Masters a specialized skill and assist with the education and training of peers *Assist with organizing topics for daily team huddles and meetings and ensure follow-ups and action items are captured and assigned *Other duties and projects as assigned

LEVEL III

*Serve as a role model for Member Advocate team adhering to the Hoag values, assisting with onboarding, training and coaching. *Serves as a source for ideation and process redesign effectively championing new workflows, new technology in automation and decision support *Co-manage cases with nurses and social workers, ensuring all assigned tasks are completed on time *Ensure problem resolution and participate in service recovery activities when appropriate *Other duties and projects as assigned

EDUCATION, TRAINING AND EXPERIENCE

REQUIRED:

LEVEL I

*High School Diploma or equivalent *3 years of customer service experience in any industry Or meets all requirements in Level II or Level III.

LEVEL II AND ABOVE

*Associates degree or higher OR obtaining a bachelor's degree in healthcare related field OR certified medical assistant OR Licensed Vocational Nurse OR other professional clinical certification. Equivalent years of relevant experience will be considered in lieu of education. *2 years of experience within a call center or healthcare setting with direct patient interaction.

LEVEL III

*Bachelor's degree or obtaining a bachelor's degree in healthcare related field OR certified medical assistant OR Licensed Vocational Nurse. Equivalent years of relevant experience will be considered in lieu of education. *Previous work experience working as a care coordinator, member advocate, or health care unit coordinator or similar health related job function.

PREFERRED:

LEVEL II

*Bachelor's degree or obtaining a bachelor's degree in healthcare related field OR certified medical assistant OR Licensed Vocational Nurse *Previous work experience working as a care coordinator, member advocate, or health care unit coordinator

LEVEL III

*Certified Medical Interpreter

SKILLS OR OTHER QUALIFICATIONS

REQUIRED:

LEVEL III

*Passionate, excited, and carry a positive attitude; a strong desire to simplify healthcare *Experience in providing excellent customer service and have a heighten the empathetic ability *Skills to multi-task and manage competing priorities can triage appropriately and can apply critical thinking to solve problems *Tech savvy and possess a capability to quickly learn new applications *Ability to maintain composure and compassion while addressing a high volume of competing tasks *Comfortable with ambiguity and open to collaborative environments *Strong moral compass and commitment to Hoag's values *Motivated to learn, continually improve and operate to ones fullest potential *Bilingual skills (preferred)

LICENSE AND CERTIFICATIONS

REQUIRED: NONE

PREFERRED:

 

LEVEL III

*Certified medical assistant OR Licensed Vocational Nurse (LVN), Certified Medical Interpreter

Company info

Hoag
Website : http://www.hoag.org