Health Services Patient Advocate

Building Service 32BJ Benefit Funds; New York (NY); Presencial; USD 52.000 - 76.000; Jornada completa

Descripción de la vacante

Building Services 32BJ Benefit Funds in New York, NY, seeks a Health Services Patient Advocate to support member/provider relations, enrollment, and resolution of issues across 5 Star Centers and affiliated providers. You will assist members in selecting in-network options, verify copays, and navigate billing concerns.

This role emphasizes collaboration with the Health Services team, data entry in the Health Services Database, and outreach for fund initiatives.

Formación

• Excellent organizational and prioritizing skills.
• Ability to work on simultaneous projects with diverse groups.
• Clear communication of ideas and thoughts.
• Ability to work with minimal supervision and be a team player.
• Ability to work in a fast-paced environment and handle multiple tasks.
• Strong listening skills and ability to address member concerns.
• Work well with physicians and other medical professionals.
• Creative thinking and solution implementation for member needs.
• Navigate multiple systems and software as needed.
• English reading/writing proficiency is essential.

Responsabilidades

• Cultivate relationships with 5 Star Center management to resolve member issues from first inquiry to resolution.
• Assist members in selecting appropriate providers and scheduling at 5 Star Centers.
• Explain medical options and alternatives to members based on criteria.
• Investigate complaints and advocate for resolution with providers.
• Identify patterns in program issues and notify management.
• Address member concerns about Health Fund programs.
• Complete enrollment processes for eligible members.
• Use Health Services Database to track interactions.
• Verify copays and research claims for billing errors.
• Assist with in-network vs out-of-network provider status checks.
• Research uncommon procedures to aid transition of care decisions.
• Shadow new employees on workflows and processes.
• Handle special projects as required by management.
• Reach out to members for upcoming fund initiatives.
• Contact unresponsive members to ensure process completion.
• Handle escalated outreach requests.
• Receive calls regarding program, billing, and medical services.
• Escalate claim issues to management and relay outcomes.
• Backup member services queue as needed.
• Attend team meetings and log issues in tracking system.

Conocimientos

Organizational skills

Prioritizing skills

Communication skills

Teamwork

Bilingual English/Spanish

Multitasking

Customer service

Educación

High School Diploma

Associate’s degree or healthcare experience

Microsoft Office proficiency

Healthcare terminology knowledge

Insurance/claims processing background

Descripción del empleo

Non Exempt

Additional Compensation for Bilingual: $1,000/annually

53A

No

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

Work Environment

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.