Member Care & Benefits Advocate

TakeCare Insurance Company, Inc.; Guam; On-site; USD 42,000 - 54,000; Full time

Job summary

TakeCare Insurance Company, Inc. seeks a Patient Advocacy Representative to act as advocate for members, coordinating coverage, care options, and billing inquiries with Medical Management, Claims and Customer Service.

You will gather relevant data for care management review and help route resolutions across internal departments and external contacts. The role also involves educating members on benefit coverage, handling inquiries, and preparing documentation for care coordination and approvals.

Qualifications

• Graduate of associate degree or four-year course or work experience equivalence.
• Working knowledge of medical terminology.
• Exceptional written/oral communication skills.
• Ability to interface with all sorts of people and handle difficult situations.
• Superior customer service and problem solving skills with strong computer skills.
• Ability to maintain confidentiality.
• Minimum of 3 years’ experience in care coordination, member issue resolution, issue documentation and member communication.
• Behavioral sensitivity, diplomacy and tact in complex situations and handling irate customers.
• Familiarity with federal and state healthcare laws and requirements.

Responsibilities

• Functions as Patient Representative and Advocate for TakeCare members.
• Communicate member-related coordination and coverage problems with internal departments.
• Maintain list of members for monitoring, reporting and follow-up on coordination and billing issues.
• Support Medical Management in care coordination and approval of covered services.
• Interact with members regarding eligibility, coverage and care options on and off site.
• Receive, document, research and respond to member inquiries related to care coordination and claims billings.
• Gather information for case reviews and provide recommendations for care coordination and approval pathways.
• Prepare correspondence and documentation in response to inquiries related to care coordination and service approvals.
• Coordinate problem resolution among departments and external resources.
• Educate members on benefit coverage and coordination processes, and claims billing.
• Assist in monthly statistics reports for care coordination and referrals for dashboards.

Skills

Communication skills

Customer service

Problem solving

Confidentiality

Interpersonal skills

Medical terminology

Education

Associate degree

4-year degree

Tools

Microsoft Office

EHR systems

Job description

TakeCare Insurance Company, Inc. seeks a Patient Advocacy Representative to act as advocate for members, coordinating coverage, care options, and billing inquiries with Medical Management, Claims and Customer Service.

You will gather relevant data for care management review and help route resolutions across internal departments and external contacts. The role also involves educating members on benefit coverage, handling inquiries, and preparing documentation for care coordination and approvals.