Health Services Patient Advocate

Building Service 32BJ Benefit Funds; New York (NY); On-site; USD 63,000 - 65,000; Full time

Job summary

Building Services 32BJ Benefit Funds is seeking a Health Services Patient Advocate in New York. You will maintain relationships with 5 Star Centers, support health fund programs, and assist members with choosing in-network providers.

The role requires strong organization, communication, and knowledge of healthcare terms. Bilingual English/Spanish is preferred. Working hours are 9:00 AM–5:00 PM, with a focus on member satisfaction and program enrollment.

Qualifications

• High School Diploma required.
• Associate degree or equivalent work experience in healthcare preferred.
• Microsoft Office (Word and Excel) proficiency required.
• Strong knowledge of healthcare industry and medical terminology.
• Insurance/managed care and claims processing background a plus.

Responsibilities

• Cultivate relationships with 5 Star Centers to address member issues from inquiry to resolution.
• Assist members with selecting providers and scheduling at 5 Star Centers.
• Review cases and communicate advantages of medical options; address limitations.
• Investigate member complaints and advocate when a complaint is filed against 5 Star providers.
• Identify patterns of Health Fund program issues and notify management.
• Address member concerns about Fund programs.
• Complete program enrollment processes for eligible members.
• Utilize Health Services Database to track interactions.
• Verify copays and research claims to identify billing errors.
• Assist with out-of-network and non-preferred providers and find in-network alternatives.
• Confirm provider network status by contacting offices.
• Conduct research on uncommon procedures for transition of care.
• Shadow new employees on workflows and case management.
• Participate in team meetings and special projects as requested.
• Reach out to members for upcoming fund initiatives.
• Reach out to unresponsive members to ensure process completion.
• Handle escalated outreach requests.
• Receive calls about Health Fund programs and billing issues.
• Escalate claims issues to management.

Skills

Organizational skills

Multitasking

Communication

Teamwork

Adaptability

Active listening

Medical collaboration

Creative thinking

Systems navigation

English proficiency

Education

High School Diploma

Associate degree

Microsoft Office (Word, Excel)

Healthcare knowledge

Insurance/Managed Care background

Tools

Microsoft Office

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Full Time New York, NY, US

2 days ago Requisition ID: 2098

$62,974.18 To $65,276.85 Annually

Job Code
892

Department Name
Health Services

Reports To
Health Services Manager

FLSA Status
Non Exempt

Additional Compensation for Bilingual: $1,000/annually

Union Code
53A

Management
No

About Us:

Building Services 32BJ Benefit Funds (“the Funds”) is the umbrella organization responsible for administering Health, Pension, Retirement Savings, Training, and Legal Services benefits to over 100,000 SEIU 32BJ members. Our mission is to make significant contributions to the lives of our members by providing high quality benefits and services. Through our commitment, we embody five core values: Flexibility, Initiative, Respect, Sustainability, and Teamwork (FIRST). By following our core values, employees are open to different and new ways of doing things, take active steps to improve the organization, create an environment of trust and respect, approach their work with the intent of a positive outcome, and work collaboratively with colleagues.

The Funds oversees and manages $9 billion of dollars in assets, which are made up of many, varied and complex funds. The dollars come from a number of sources, including the property owners who pay into the funds on behalf of their employees, and as such, requires those who oversee and manage the money to be highly skilled financial management people.

For 2025 and beyond, 32BJ Benefit Funds will continue to drive innovation, equity, and technology insights to further help the lives of our hard-working members and their families. We use cutting edge technology such as: M365, Dynamics 365 CRM, Dynamics 365 F&O, Azure, AWS, SQL, Snowflake, QlikView, and more.

Please take a moment to watch our video to learn more about our culture and contributions to our members: youtu.be/hYNdMGLn19A

Job Summary:

This position is a key part of developing, expanding, and maintaining the Health Fund programs. The Health Services Patient Advocate is responsible for the maintenance of relationships with the 5 Star Centers, supporting the operations of the Health Fund Programs, responding to member and provider issues, and assisting members in choosing in-network providers, particularly 5 Star Centers and partnered providers. The Patient Advocate for Health Services addresses member concerns from the initial inquiry stage through resolution, engages in marketing strategies, and offers insights for ongoing quality enhancement of the Health Services Team. Furthermore, this role also contributes to various operational support tasks within the Health Services Team.

Essential Duties and Responsibilities:

• Cultivate relationships with management and administrative staff at specified 5 Star Centers to assist in addressing member issues as they arise from the first inquiry to the resolution
• Assist members with selecting appropriate providers based on medical criteria and scheduling appointments at 5 Star Centers
• Review cases and directly communicate advantages of medical options while also addressing the limitations or alternative options available to members
• Investigate member complaints and serve as advocates when a complaint is filed against 5 Star providers to determine a resolution
• Investigate and identify any patterns and/or trends of Health Fund program issues with service provision and address accordingly or notify management
• Address member concerns about Fund programs
• Complete all program enrollment processes for eligible, interested members
• Utilize Health Services Database to track interactions related to fund programs
• Work with members and the providers to verify the correct copay and research claims to identify all billing errors
• Handle and address cases involving out-of-network and non-preferred providers and offer members alternatives for in-network and preferred providers
• Confirm if the provider is truly in-network or out-of-network, considering situations where providers may have varying statuses at different sites. Reach out to the provider's offices directly to verify their network status, location information, and participation details
• Conduct research on uncommon procedures and verify the provider's capability to deliver services to effectively assist members in making intricate decisions regarding their transition of care
• Perform side-by-side shadowing with new employees on all workflows, systems, and case management processes
• Perform other tasks and special projects as required by management
• Reach out to members and dependents who meet specific criteria for upcoming fund initiatives and our programs
• Reach out to members who are unresponsive to third party administrators and vendors to ensure the correct process is followed from initial through completion of care
• Handle escalated outreach requests
• Receive incoming calls through the Health Services queue regarding Health Fund Programs, billing/claim issues and medical services
• Direct escalated claim issues to management and Claims Specialist and relay the outcomes to members
• Back up member services provider line queue upon request for provider search activity
• Attend and participate in all team meetings
• Log member issues into the department tracking system

Qualifications (Competencies):

• Excellent organizational and prioritizing skills
• Work on simultaneous projects with diverse working groups
• Ability to clearly communicate ideas and thoughts
• Work with minimal supervision and be an effective team player
• Effectively work in a fast-paced environment, handle multiple tasks and prioritize work
• Excellent listening skills and ability to address member concerns
• Work well with physicians and other medical professionals
• Think creatively and implement solutions to meet member needs
• Navigate multiple systems simultaneously
• Read, write and understand English is essential

Education:

• High School Diploma
• Associate’s degree or equivalent work experience in the healthcare industry
• Microsoft Office with emphasis on Word and Excel
• Strong knowledge base of healthcare industry and medical terminology
• Insurance/managed care and claims processing background a plus

Language Skills:

• Bilingual in English/Spanish is preferred

Shift

9:00 AM to 5:00 PM

Physical Demands:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.

• Under 1/3 of the time: Standing, Walking, Climbing or Balancing, Stooping, Kneeling, Crouching, or Crawling
• Over 2/3 of the time: Talking or Hearing
• 100% of the time: Using Hands

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• 1/3 to 2/3 of the time: Work near moving or mechanical parts, exposure to radiation, moderate noise.