Advanta Advocate

MedImpact•Tempe, AZ

30d•$18 - $28•Onsite

About The Position

Verdegard is looking for extraordinary people to join our team! Why join Verdegard? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. Job Description Summary Works as a member of the Advanta Advocate team working directly with enrolled employees (members) on their medical health insurance plan. The Advocates negotiate with facilities and providers working towards obtaining the best care at the best price for their health needs. Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform the functions of the job. Essential Duties and Responsibilities include the following. Other duties may be assigned. Advocates coordinate and communicate Pre and Post Service cases between operation, account management, sales, health services, stop loss, finance, clients, brokers, facilities and members. Convey a positive image of the company by promptly responding to member phone inquiries and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance. Deliver service that meets or exceeds department performance standards when negotiating with facilities, providers and the delivery of options to members. Utilize company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other TPA processes. Request follow-up action or obtain assistance from other areas of the organization as necessary. Educate external customers/members about Verdegard’s roles and responsibilities. Provide information about override guidelines, benefit plans, prior authorization requirements, grievance and appeal processes, and other TPA functions as specified by health plan sponsors in accordance to their health plan. Follow up with customers/members as appropriate to ensure satisfaction and timely response to requests. Diffuse upset customers/members by appropriately listening to issues and providing positive solutions to resolve concerns. Represent Verdegard in a positive manner by adhering to processes and established procedures and guidelines. Support the department strategy by working with the customer/member to have the best experience with their health plan and help find financial savings through negotiations with their providers and facilities and redirecting to more cost-effective provider locations.

Requirements

GED/HS Diploma and 2+ years’ experience or equivalent combination of education and experience
Intermediate knowledge of MS Office/Word, Excel, and Outlook and aptitude for new programs.
Experience with Windows based database programs is also required.
Demonstrates ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Ability to apply concepts of basic algebra and geometry.
Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Responsibilities

Advocates coordinate and communicate Pre and Post Service cases between operation, account management, sales, health services, stop loss, finance, clients, brokers, facilities and members.
Convey a positive image of the company by promptly responding to member phone inquiries and determining the appropriate actions to resolve issues, gather and provide information, and offer assistance.
Deliver service that meets or exceeds department performance standards when negotiating with facilities, providers and the delivery of options to members.
Utilize company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other TPA processes.
Request follow-up action or obtain assistance from other areas of the organization as necessary.
Educate external customers/members about Verdegard’s roles and responsibilities.
Provide information about override guidelines, benefit plans, prior authorization requirements, grievance and appeal processes, and other TPA functions as specified by health plan sponsors in accordance to their health plan.
Follow up with customers/members as appropriate to ensure satisfaction and timely response to requests.
Diffuse upset customers/members by appropriately listening to issues and providing positive solutions to resolve concerns.
Represent Verdegard in a positive manner by adhering to processes and established procedures and guidelines.
Support the department strategy by working with the customer/member to have the best experience with their health plan and help find financial savings through negotiations with their providers and facilities and redirecting to more cost-effective provider locations.