Job Description:
Summary
The Health Care Advisor will be offering broad experience and knowledge in health care, insurance, and employer benefits. Your empathy and compassion, partnered with your insurance experience and health care expertise, will be critical to assisting customers in resolving complex issues. You will be responsible for answering inbound calls from our customers and listening intently to their situation to be sure you gather the necessary information needed to obtain an accurate resolution. You will be responsible for frequent engagement with our customers, and leverage your strong ability to navigate the complex healthcare industry with timely interactions with internal and external customers, insurance carriers, and healthcare providers, to resolve issues.
Detailed Responsibilities
- Handle incoming complex calls offering compassion and empathy while using exceptional listening skills to identify the customer's needs.
- Identify the health insurance needs of customers, accurately answer questions, address concerns, and recommend an appropriate plan
- Provide accurate information to customers regarding the Affordable Care Act (ACA)
- Actively listen to identify custom needs by utilizing probing questions
- Resolve customer needs or concerns related to:
- identification of in-network providers or physician specialists
- delay or denial of treatment
- claims processed or denied incorrectly
- clarification and education on general or specific benefit plans or programs
- resolution of prescription / drug access or cost issues
- coordinate access to clinical support for education regarding a diagnosis or treatment plan
- specialty services for complex treatment plans
- Full accountability for research and resolution of the customer's issue including bring in additional resources and communicating final resolution.
- Review specific employer plan provisions pertinent to resolving customer questions or concerns
- Investigate identified issue by interacting with the health plan, provider, and other third parties as needed.
- Confidently educate customer by being proficient with all employer health benefit tools and resources
- Refer customers to broader employer programs and available tools
- Make outbound/follow-up calls, to provide resolution, to the issue by sharing requested information, educating the customer on how a benefit 'works' or referring them to a program for additional support.
- Document all research and summarize calls in the case management system
- Become a resource and/or subject matter expert for your aligned employers
- Deliver a consistently positive customer experience in a highly ethical and professional manner
- Identify learnings/trends and provide recommended ideas/solutions to share back with the broader customer service team
- Identify barriers for customers attempting to access care
Competencies, Knowledge & Experience
Education & Certification
3 years relevant experience in health plan benefits
OR
2 year degree in a health related field
A plus:
- In Illinois Health and Accident License and/or Life License
- In Texas Life, Accident, Health & HMO License
Work Experience
- Detailed knowledge of health benefits, including PPO plans, High deductible, HSAs and HRAs,
- Understanding of specific plan coverages and exclusions in medical, prescription, dental, vision, and behavioral health/substance abuse
- Preferred knowledge or experience in at least one of the following:
- Affordable Care Act
- Medical claim handling, processing and billing
- Health Savings Account
- Carrier & medical provider interactions
- Carrier case management
-
- Proven track record of health care insurance and/or commercial insurance sales
- Experience with desktop/Windows navigation and keyboarding skills.
- Experience with MS Word, Excel, SharePoint, and Outlook
Qualifications
- Aptitude for understanding details of health insurance products and compliance with all regulations
- Exceptional listening skills
- Excellent customer service expertise, with both email interactions and on the phone
- Problem solving, critical thinking, and analytical skills
- Strong organizational and time management proficiencies
- Flexible and adaptable with a demonstrated ability to recognize the need to change priorities to meet the business needs.
- Ability to work independently while providing support in a team environment
- Strong written and verbal communication skills
- Ability to execute thorough and detailed documentation
Other
Work Conditions
- Frequent computer use at a workstation for extended periods of time.
- Access information using a computer and related components and peripherals.
- Participate in training sessions and meetings.
- Ability to be flexible with various shifts and possible overtime when business needs require.
- Ability to coordinate phone time including making outbound calls and receiving inbound calls consecutively throughout the day
We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.
DISCLAIMER:
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.
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