Advanta Advocate (Biligual)

medimpact; Tempe (AZ); On-site; USD 27,000 - 43,000; Full time

Job summary

Verdegard is seeking an Advanta Advocate to work with enrolled employees on their medical health insurance plan. The role focuses on negotiating with facilities and providers to obtain the best care at the best price, while delivering outstanding service and information to members.

Spanish/English speaking required, with general supervision and adherence to company guidelines. The candidate will coordinate Pre and Post Service cases, respond to inquiries, educate customers on plan details, and

Qualifications

• GED/HS Diploma and 2+ years' experience or equivalent combination of education and experience.
• Proficient with MS Office (Word, Excel, Outlook) and basic database tools.
• None required for Certificates, Licenses, Registrations.

Responsibilities

• Coordinate and communicate Pre and Post Service cases across departments and clients.
• Respond promptly to member inquiries, determine actions, and provide information.
• Deliver service that meets or exceeds performance standards during negotiations.
• Utilize database programs to research and resolve benefit information and claims.
• Educate members about guidelines, plans, prior authorization, and processes.
• Follow up with customers to ensure satisfaction and timely responses.

Skills

Bilingual Spanish/English

Customer service

Interpersonal communication

Education

GED/HS Diploma

Tools

Windows-based databases

Job description

Exemption Status:

United States of America (Non-Exempt)

Exemption Status:

$19.80 - $25.50 - $31.19

"Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate."

Verdegard is looking for extraordinary people to join our team!

Why join Verdegard?

Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

Job Description

Summary

Spanish/English Speaking required

Works as a member of the Advanta Advocate team working directly with enrolled employees (members) on their medical health insurance plan. The Advocates negotiate with facilities and providers working towards obtaining the best care at the best price for their health needs. Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform the functions of the job.

Essential Duties and Responsibilities

Include the following. Other duties may be assigned.

• Advocates coordinate and communicate Pre and Post Service cases between operation, account management, sales, health services, stop loss, finance, clients, brokers, facilities and members.
• Convey a positive image of the company by promptly responding to member phone inquiries and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance.
• Deliver service that meets or exceeds department performance standards when negotiating with facilities, providers and the delivery of options to members.
• Utilize company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other TPA processes. Request follow-up action or obtain assistance from other areas of the organization as necessary.
• Educate external customers/members about Verdegard's roles and responsibilities. Provide information about override guidelines, benefit plans, prior authorization requirements, grievance and appeal processes, and other TPA functions as specified by health plan sponsors in accordance to their health plan.
• Follow up with customers/members as appropriate to ensure satisfaction and timely response to requests. Diffuse upset customers/members by appropriately listening to issues and providing positive solutions to resolve concerns.
• Represent Verdegard in a positive manner by adhering to processes and established procedures and guidelines. Support the department strategy by working with the customer/member to have the best experience with their health plan and help find financial savings through negotiations with their providers and facilities and redirecting to more cost-effective provider locations.

Supervisory Responsibilities

No supervisory responsibilities

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

GED/HS Diploma and 2+ years' experience or equivalent combination of education and experience

Computer Skills

Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs. Experience with Windows based database programs is also required.

Certificates, Licenses, Registrations

None required

Other Skills and Abilities

Demonstrates ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability