Advanta Advocate (Biligual)

MedImpact Healthcare Systems, Inc.•Tempe, AZ

23d•$20 - $31•Onsite

About The Position

Works as a member of the Advanta Advocate team, working directly with enrolled employees (members) on their medical health insurance plan. Advocates negotiate with facilities and providers to help members obtain the best care at the best price for their health needs. The role interacts with internal and external customers to provide and obtain information and ensure outstanding service and quality. It works under general supervision, using instructions, work process guidelines, policies and procedures, and company knowledge and experience. This is a Spanish/English-speaking, internal- and external-client-facing position requiring excellent customer service and interpersonal communication skills. The position is non-exempt and full-time, based on-site at the Tempe location. Typical hours are Monday through Friday, 7:00 a.m. to 4:00 p.m.; overtime and work at night, on weekends, or on holidays may be required as business needs dictate.

Requirements

Spanish and English speaking ability is required.
GED or high school diploma and at least 2 years of experience, or an equivalent combination of education and experience.
Intermediate knowledge of Microsoft Office, including Word, Excel, and Outlook, and aptitude for learning new programs.
Experience with Windows-based database programs is required.
Ability to meet the customer-service, interpersonal communication, listening, verbal, and written communication demands of an internal- and external-client-facing role.
Ability to manage difficult or emotional client situations, respond promptly to client needs and service requests, solicit feedback, and meet commitments.
Ability to follow instructions, work rules, procedures, and corporate policies; interact well with coworkers; accept constructive criticism; establish goals; and demonstrate initiative and commitment.
Ability to apply common-sense understanding to written, oral, or diagrammed instructions and address 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, and apply basic algebra and geometry concepts.
Ability to present information effectively in one-on-one and small-group settings.
Ability to sit, talk, or hear regularly; stand, walk, use hands to handle or feel objects, and reach with hands and arms regularly; and occasionally lift or move up to 25 pounds.
Ability to work overtime from time to time, including nights, weekends, or holidays as required.
Ability to work on-site at the Tempe location; remote work is not an option.

Responsibilities

Coordinate and communicate pre- and post-service cases among operations, account management, sales, health services, stop loss, finance, clients, brokers, facilities, and members.
Respond promptly to member phone inquiries, determine appropriate actions, resolve issues, gather and provide information, and offer assistance.
Negotiate with facilities and providers and deliver options to members in a way that meets or exceeds department performance standards.
Use company database programs to research and resolve issues involving benefit information, claims adjudication, eligibility verification, prior authorization, and other third-party administrator processes; request follow-up or assistance from other departments as needed.
Educate members and other external customers about Verdegard’s roles and responsibilities, override guidelines, benefit plans, prior authorization requirements, grievance and appeal processes, and other plan-specific third-party administrator functions.
Follow up with members and customers as appropriate to ensure satisfaction and timely responses; listen to concerns and provide positive solutions to defuse difficult interactions.
Follow established processes, procedures, and guidelines while representing the company positively.
Help members have a positive health-plan experience and find financial savings by negotiating with providers and facilities and redirecting members to more cost-effective provider locations.