Health Pro Consultant - US Virtual

Alight Solutions

1d•Remote

About The Position

Our story At Alight, we believe a company’s success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to “Be Alight.” We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management. As a Health Pro, you can expect the following: When you start, you will receive extensive health care and case management training to ensure you are equipped to support members on complicated healthcare matters. Your primary responsibility is to be an advocate for members requiring guidance across the health benefits environment by helping them navigate questions about their benefits, identify the highest quality and cost-effective providers, understand benefit claims, and be an advocate for the employee across the health ecosystem. You will gather a full understanding of the members’ needs and own the resolution of the customer’s request. This work involves leveraging developed methodologies, navigating internal tools and applications, as well as making external phone calls, partnering with carriers and providers (via email and phone outreach) to resolve member needs. The scope of work is dedicated at the employee level and you will be responsible for working employee cases through resolution. You will interact with members through incoming calls, emails, and messaging system interactions. You will be responsible for utilizing exceptional communication, empathy, and problem solving skills to understand and solve complex customer needs, resulting in a better experience for the employee’s entire healthcare journey.

Requirements

Minimum of 2 years of experience in a medical assistant/medical support role, or 3 years of experience working in a customer-facing role within the healthcare industry
Ability to work effectively in a remote team environment
Strong listening, reasoning, and analytical skills – ability to listen to members’ needs and dig deeper to understand the root cause of their concern with empathy.
Exceptional verbal and written communication skills – can convey complex concepts, both verbally and in writing, for members that are not benefits experts
Strong ability and desire to learn continually in a changing environment
Exceptional critical thinking and problem-solving skills
Ability to efficiently organize work activities to meet deadlines
Passion to provide the highest level of client satisfaction
Ability to receive and immediately apply constructive feedback
Ability to develop effective rapport with clients based on empathy and trust
Proficiency in MS Office suite
Authorization to work in the Employing Country

Responsibilities

Gathering information about the reason the customer is seeking support or care
Educating members on benefit programs provided by clients
Translating complex benefit details (e.g., deductibles, coverage limits, prior authorizations) into clear, actionable guidance members can understand and use
Delivering provider recommendations, referral guidance, and connections to clinical or employer‑sponsored programs to support informed care decisions
Completing cost estimates and communicating out‑of‑pocket responsibility, claim results, denials, appeals, and escalation outcomes with accurate expectations and timelines
Explaining prescription formulary options, prescription alternatives, prior authorization outcomes, and available cost‑saving opportunities
Proactively identifying unmet clinical needs and owning the connection to appropriate clinical support and care resources
Connecting members to company sponsored health and benefits programs for specialized care
Providing proactive, timely updates via phone and digital channels and ensuring members feel supported through full case resolution
Navigating medical bill review results, including identified errors and savings achieved, and translating findings into clear, actionable guidance for members
Drafting carrier and client appeals for healthcare services
Coordinating records transfers and authorization requests that require pre-service approval