Member Experience Advisor - Clinical Support

About Us:

NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members.

Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction.

Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members.

We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.

Role:

Member Experience Advisor - Clinical Support will apply knowledge and skills to engage in a depth discussion with members about medication to identify, educate, and resolve many barriers to medical and or pharmaceutical care. The role will involve analysis and problem solving to obtain a resolution. Applied judgement is required to develop, educate, modify, and adapt procedures in order to be most effective given the demands and atypical situations.

Essential Duties and Responsibilities:

• Make outbound and inbound calls to customers and providers related to disease metrics and management, medication information, and problem resolutions related to medications or care.
• Utilize interpersonal skills to establish a strong relationship that allows for direct probing to uncover the member’s needs.
• Respond swiftly and courteously to all potential customer inquiries.
• Utilize effective motivational interviewing clinical techniques to influence the member to take action.
• Learn product portfolio quickly and discuss options and features in detail.
• Resolve member inquiries at the first point of contact.
• Educate members on products or services that will enhance their quality of life
• Demonstrate active listening, understand customer questions, and provide accurate responses or solutions for barriers to care. More complex questions, inquiries, or information request outside the scope of knowledge are transferred to the health plan, provider or pharmacy for resolution.
• Show empathy both in word choice and intonation to all members.
• Interact with all levels of health care professionals related to patient care or medications, including explaining benefits and insurance coverage grids.
• Use software application to document all resolutions of the customers or provider end call disposition.
• Nature of the work requires minimal supervision, and largely self directed and accountable for defined duties. Job requires the use of interpersonal judgement. Remain confidential with all proprietary information.
• Offer a sales rebuttal that addresses a member's objections and presents solutions.
• Provide knowledge and in-depth advice for hearing loss and hearing aids.
• Competitive, self-motivated, exercise excellent written, verbal, listening and inter-personal communication skills necessary to effectively interact and communicate with internal and external parties, convey accurate information correctly, manage difficult situations

Education & Certification Requirements:

• High School Diploma or GED with Clinical license type Licensed Practical Nurse (LPN), Certified Pharmacy Tech (CPht), Certified Medical Assistant (CMA), Certified Nurses Assistant (CNA), Certified Medication Aide (CMA).
• Must meet at least one of the license requirements Licensed Practical Nurse (LPN), Certified Pharmacy Tech (CPht), Certified Medical Assistant (CMA), Certified Nurses Assistant (CNA), Certified Medication Aide (CMA), or have a former licenses with recent working pharmacology terminology experience in lieu of an active licenses.
• Proficient in Microsoft Word, Excel, Google an d willingness to learn new software as needed.

Qualifications:

• At least two-five years related experience and or training equivalent combination of education, medical or pharmacy care, or interacting with patients or members of a health plan.
• Experience handling high call volumes and make sound business decisions in an efficient manner.
• Exposure and/or interest in healthcare products and outcomes
• PC proficiency required.
• Excellent listening and interpersonal skills
• Excellent communications skills
• Multi-task oriented
• Attention to detail and quality oriented.
• Analytical thinker and problem solver
• Strong written and oral communication including effective communication through out the organization.
• Handle all situations with calm & positive manner.
• Pick up new process quickly in a fast-paced environment