Member Service Advocate-1

Point32Health•Canton, MA

3d•$21 - $21

About The Position

At Point32Health, we’re driven by a shared purpose: to lead and empower healthier lives for everyone. Our colleagues are deeply committed to giving back to the communities where they live and work, and we’re looking for team members who want to be part of something bigger—an organization that values compassion, collaboration, and impact. Under the general direction of the Service Center Supervisor, the Member Services Advocate provides exceptional customer service, navigating the complexities of the healthcare system, dressing inquiries, resolving issues and ensuring members have a positive experience with Point 32 Health. The Member Service Advocate is a member champion to resolve issues internally with a wide variety of departments and interacting externally with providers, employers, brokers and provider billing offices to assist with issue resolution. A candidate should be proficient in working in multiple systems at once while doing real-time analysis of data and documentation to resolve member inquiries. Training Hours: 8:30 AM – 5:00 PM EST, M - F. Must have 100% attendance during training. Working as a Member Advocate provides you with hands-on experience to grow your career with Point32Health. With demonstrated initiative and strong performance, you will gain exposure across a multitude of functions providing you with opportunities for advancement. A Member Services Advocate can grow not only within the department but also throughout Point32Health.

Requirements

Associate degree or equivalent work experience
0-2 years of relevant experience.
Customer Service Expertise- Demonstrated ability to provide exceptional service, including active listening, empathy, and clear communication with members.
Empathy- Ability to put yourself in someone else’s shoes and demonstrate compassion.
Product Knowledge - Strong understanding of health insurance products, policies, and industry regulations, or the ability to quickly learn and apply new information.
Problem-Solving/Critical Thinking Skills- Adept at identifying issues, analyzing information, and providing effective solutions in a timely manner.
Communication Skills- Excellent verbal and written communication skills, with the ability to convey complex information clearly and professionally.
Attention to Detail- High level of accuracy in handling member information, processing requests, and documenting interactions.
Multitasking Ability- Capable of managing multiple tasks simultaneously while maintaining focus and efficiency.
Technical Proficiency- Comfortable using computer systems, CRM software, and other relevant technology to manage member interactions and data.
Adaptability - Ability to adjust to changing priorities and new processes in a dynamic work environment.
Team Collaboration- Strong people skills with the ability to work effectively with team members and contribute to a positive work atmosphere.
Conflict Resolution - Skilled in managing and resolving conflicts and complaints with professionalism and patience.
Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May be required to work additional hours beyond standard work schedule.

Nice To Haves

Bachelor’s degree or equivalent work experience preferred.
Customer service experience in health care, call center or corporate office.
Knowledge of medical terminology.
Prior experience training and working in a virtual/remote setting.

Responsibilities

Inbound Call Management - Handle inbound calls from members with professionalism and attentiveness, addressing inquiries related to health insurance benefits, coverage, claims and eligibility.
Health Care System Navigation - support and advocate for members to ensure that they receive the care/support needed
Problem Resolution - Provide education and guidance to members about their Point32Health benefits and take ownership of each call to ensure that issues are resolved promptly and accurately. Follow up with members as needed to ensure complete resolution.
Member Engagement - Assist members in understanding and accessing theit benefits and educate members on how to use self service tools, deliver proactive/anticpatory service
Documentation and Reporting- Record call details and member interactions in the system accurately, ensuring that all relevant information is documented for future reference and reporting ensuring HIPPA, State and Federal regulations and confidentiality standards are met.
Team Collaboration - Work collaboratively with other team members and departments to address complex issues and ensure a seamless member experience.
Member Experience- As a brand ambassador for Point32Health, go above and beyond to ensure member satisfaction, proactively identifying and addressing needs and concerns.
Continuous Improvement- Represent the voice of the customer by contributing to continuous improvement initiatives and providing feedback on member interactions and suggesting process enhancements.
Metrics & Goals- Adhere to assigned schedules to ensure appropriate phone queue coverage & meet or exceed department established key performance indicators
Member Retention & Outbound Campaigns- Execute outbound calls to improve the member experience and assist in member retention
Compliance and Policy Adherence- Ensure all interactions are HIPAA compliant and adhere to state and federal regulations
Other duties as assigned.

Benefits

Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health

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