Member Advocate Associate

Act as a compassionate advocate for our members by helping them navigate the healthcare system, providing them with an understanding of their health benefits while supporting them throughout their healthcare journey. The Advocate Associate will educate, and guide members to ensure they maximize their available benefits and achieve their best health. This role requires strong communications skills, problem solving skills, empathy, and compassion. The Advocate Associate will provide excellent service through the resolution of member inquiries received by phone or through written correspondence (email and chat). The Advocate Associate is responsible for helping members navigate and access physician and healthcare services, community programs, and other resources, as well as answer and / or address benefit and health plan questions. This position acts as a liaison collaborating with the Horizon Care Management team, Physicians / physician practices and Delegated Vendors to support the member.

The Advocate Associate will be able to support the responsibilities listed below and includes managing in and outbound digital, telephonic, and written correspondence, initiating appeals and processing claims.

Job Responsibilities :

• Acts as a single point of contact for members to establish a trusted relationship with members. Assists members with finding providers, resolving problems, and answering questions regarding anything from how to obtain services with providers and community services to how to initiate and file an appeal to processing claims.
• Explains plan benefit design, resolves claims, benefits during the interaction with the member (digitally or telephonically). Asks probing questions to identify member needs, inclusive of those beyond current healthcare benefits.
• Receive, research, and resolve in and outbound member inquiries via phone, mail, e-mail and chat. Works to increase member's engagement in appropriate programs and offerings. Engages with members by assisting with scheduling appointments (e.g., with providers, obtaining transportation services etc.), finding providers, using online tools, obtaining a new ID card and accessing care.
• Proactively outreaches to identified members for specific campaigns around addressing health and wellness gaps. Initiate call backs and / or written correspondence to members and providers to coordinate follow-ups and member care.
• Acts as liaison with providers, Care Managers, and vendors. Advocates will warm transfer members internally to other teams and / or third-party vendors depending on member needs. Advocates will act as champions of members by providing a summary of the member’s problem / inquiry with the receiving party prior to making warm transfers and if needed support the member by remaining on the line to ensure the member’s inquiry gets resolved.
• Routinely engages and collaborates with healthcare providers and internal teams to resolve member issues and provide a seamless member experience. Captures actions and promises a timeframe by when follow-up will be completed with members to set clear expectations, demonstrate a commitment to shared goals and so that members do not need to takeaway actions from the interaction.
• Identifies and resolves problems related to any barriers to care or gaps in coverage that may affect the member’s health outcomes. Provides education, resources, and solutions whenever possible (digitally or telephonically) to help members maximize their benefits.
• Educates members about preventive health activities, wellness programs and services to close gaps in care.
• Perform other relevant tasks as assigned by management.

Disclaimer :

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education / Experience :

Knowledge :

Skills and Abilities :

Travel (If Applicable) :

Role requires travel to a Horizon office

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range : 52,645 - $69,910

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to : education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes :

Comprehensive health benefits (Medical / Dental / Vision)

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Salary : $52,645 - $69,910