Member Advocate Associate
Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.
Act as a compassionate advocate for our members by helping them navigate the healthcare system, providing them with an understanding of their health benefits while supporting them throughout their healthcare journey. The Advocate Associate will educate, and guide members to ensure they maximize their available benefits and achieve their best health. This role requires strong communications skills, problem solving skills, empathy, and compassion. The Advocate Associate will provide excellent service through the resolution of member inquiries received by phone or through written correspondence (email and chat). The Advocate Associate is responsible for helping members navigate and access physician and healthcare services, community programs, and other resources, as well as answer and/or address benefit and health plan questions. This position acts as a liaison collaborating with the Horizon Care Management team, Physicians/physician practices and Delegated Vendors to support the member.
The Advocate Associate will be able to support the responsibilities listed below and includes managing in and outbound digital, telephonic, and written correspondence, initiating appeals and processing claims.
Job Responsibilities:
Acts as a single point of contact for members to establish a trusted relationship with members. Assists members with finding providers, resolving problems, and answering questions regarding anything from how to obtain services with providers and community services to how to initiate and file an appeal to processing claims.
Explains plan benefit design, resolves claims, benefits during the interaction with the member (digitally or telephonically). Asks probing questions to identify member needs, inclusive of those beyond current healthcare benefits.
Receive, research, and resolve in and outbound member inquiries via phone, mail, e-mail and chat. Works to increase member's engagement in appropriate programs and offerings. Engages with members by assisting with scheduling appointments (e.g., with providers, obtaining transportation services etc.), finding providers, using online tools, obtaining a new ID card and accessing care.
Proactively outreaches to identified members for specific campaigns around addressing health and wellness gaps. Initiate call backs and/or written correspondence to members and providers to coordinate follow-ups and member care.
Acts as liaison with providers, Care Managers, and vendors. Advocates will warm transfer members internally to other teams and/or third-party vendors depending on member needs. Advocates will act as champions of members by providing a summary of the member's problem/inquiry with the receiving party prior to making warm transfers and if needed support the member by remaining on the line to ensure the member's inquiry gets resolved.
Routinely engages and collaborates with healthcare providers and internal teams to resolve member issues and provide a seamless member experience. Captures actions and promises a timeframe by when follow-up will be completed with members to set clear expectations, demonstrate a commitment to shared goals and so that members do not need to takeaway actions from the interaction.
Identifies and resolves problems related to any barriers to care or gaps in coverage that may affect the member's health outcomes. Provides education, resources, and solutions whenever possible (digitally or telephonically) to help members maximize their benefits.
Educates members about preventive health activities, wellness programs and services to close gaps in care.
Perform other relevant tasks as assigned by management.
Education/Experience:
High School Diploma/GED required. Associate or bachelor's degree in healthcare, Social Work, Education, Hospitality Services or a related field preferred.
Requires a minimum of 2 years of experience in healthcare, customer advocacy and navigation, benefits administration, hospitality, education, or other field that demonstrates high level of solving issues for people and navigating complex areas.
Prefers experience with successful resolution of sensitive/escalated member issues.
Experience and knowledge of claims coding/processing, Managed Care principles, medical terminology and experience in healthcare settings is a plus.
Prefer experience with training and coaching junior staff members on an ongoing basis.
Requires experience with Microsoft Office and other relevant software systems.
Knowledge:
Requires exceptional multi-channel Communication and Interpersonal skills, including the ability to explain complex concepts clearly with compassion.
Requires empathy, passion for helping others and a commitment to improving member health outcomes.
Requires excellent Oral and Written Communication skills.
Requires ability to make sound decisions.
Requires the ability to analyze and resolve problems effectively and efficiently as well as independently with minimal supervision.
Requires a candidate that can work in a collaborative team environment and is a team player who possesses strong analytical, critical thinking and interpersonal skills.
Prefer front line customer engagement experience.
Prefer knowledge of reporting on metrics for group customers as needed.
Requires ability to handle escalated member inquiries telephonically or digitally.
Skills and Abilities:
Entry level, strong PC skills
Travel (If Applicable):
Role requires travel to a Horizon office Apply Now
Act as a compassionate advocate for our members by helping them navigate the healthcare system, providing them with an understanding of their health benefits while supporting them throughout their healthcare journey. The Advocate Associate will educate, and guide members to ensure they maximize their available benefits and achieve their best health. This role requires strong communications skills, problem solving skills, empathy, and compassion. The Advocate Associate will provide excellent service through the resolution of member inquiries received by phone or through written correspondence (email and chat). The Advocate Associate is responsible for helping members navigate and access physician and healthcare services, community programs, and other resources, as well as answer and/or address benefit and health plan questions. This position acts as a liaison collaborating with the Horizon Care Management team, Physicians/physician practices and Delegated Vendors to support the member.
The Advocate Associate will be able to support the responsibilities listed below and includes managing in and outbound digital, telephonic, and written correspondence, initiating appeals and processing claims.
Job Responsibilities:
Acts as a single point of contact for members to establish a trusted relationship with members. Assists members with finding providers, resolving problems, and answering questions regarding anything from how to obtain services with providers and community services to how to initiate and file an appeal to processing claims.
Explains plan benefit design, resolves claims, benefits during the interaction with the member (digitally or telephonically). Asks probing questions to identify member needs, inclusive of those beyond current healthcare benefits.
Receive, research, and resolve in and outbound member inquiries via phone, mail, e-mail and chat. Works to increase member's engagement in appropriate programs and offerings. Engages with members by assisting with scheduling appointments (e.g., with providers, obtaining transportation services etc.), finding providers, using online tools, obtaining a new ID card and accessing care.
Proactively outreaches to identified members for specific campaigns around addressing health and wellness gaps. Initiate call backs and/or written correspondence to members and providers to coordinate follow-ups and member care.
Acts as liaison with providers, Care Managers, and vendors. Advocates will warm transfer members internally to other teams and/or third-party vendors depending on member needs. Advocates will act as champions of members by providing a summary of the member's problem/inquiry with the receiving party prior to making warm transfers and if needed support the member by remaining on the line to ensure the member's inquiry gets resolved.
Routinely engages and collaborates with healthcare providers and internal teams to resolve member issues and provide a seamless member experience. Captures actions and promises a timeframe by when follow-up will be completed with members to set clear expectations, demonstrate a commitment to shared goals and so that members do not need to takeaway actions from the interaction.
Identifies and resolves problems related to any barriers to care or gaps in coverage that may affect the member's health outcomes. Provides education, resources, and solutions whenever possible (digitally or telephonically) to help members maximize their benefits.
Educates members about preventive health activities, wellness programs and services to close gaps in care.
Perform other relevant tasks as assigned by management.
Education/Experience:
High School Diploma/GED required. Associate or bachelor's degree in healthcare, Social Work, Education, Hospitality Services or a related field preferred.
Requires a minimum of 2 years of experience in healthcare, customer advocacy and navigation, benefits administration, hospitality, education, or other field that demonstrates high level of solving issues for people and navigating complex areas.
Prefers experience with successful resolution of sensitive/escalated member issues.
Experience and knowledge of claims coding/processing, Managed Care principles, medical terminology and experience in healthcare settings is a plus.
Prefer experience with training and coaching junior staff members on an ongoing basis.
Requires experience with Microsoft Office and other relevant software systems.
Knowledge:
Requires exceptional multi-channel Communication and Interpersonal skills, including the ability to explain complex concepts clearly with compassion.
Requires empathy, passion for helping others and a commitment to improving member health outcomes.
Requires excellent Oral and Written Communication skills.
Requires ability to make sound decisions.
Requires the ability to analyze and resolve problems effectively and efficiently as well as independently with minimal supervision.
Requires a candidate that can work in a collaborative team environment and is a team player who possesses strong analytical, critical thinking and interpersonal skills.
Prefer front line customer engagement experience.
Prefer knowledge of reporting on metrics for group customers as needed.
Requires ability to handle escalated member inquiries telephonically or digitally.
Skills and Abilities:
Entry level, strong PC skills
Travel (If Applicable):
Role requires travel to a Horizon office Apply Now