Job Description
POSITION SUMMARY
The Member Advocate is responsible for managing all plan member communications within the Allied Advocate Department. This role supports members throughout the entire advocacy process, beginning with initial written communication and concluding with a final call to explain resolution outcomes. Communication may occur in both written and verbal formats.
The Advocate must be comfortable utilizing Language Line interpreter services to support members with diverse language needs and demonstrate a working knowledge of Affordable Care Plans (ACP) plans and Minimum Essential Coverage (MEC) plans.
ESSENTIAL FUNCTIONS
- Confer with members by telephone and/or email to answer questions or provide information in response to inquiries on Allied Advocate claims.
- Contact members to respond to inquiries or to notify them of claim investigation results and any planned adjustments.
- Coordinate with member and/or client services to obtain a signed HIPAA release to aide with the negotiation process.
- Keep records of member and provider interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
- Obtain and examine all relevant information to assess need for negotiation on balance due issues.
- Work with other departments (Account Management, Client Services, Customer Service) as needed to resolve member issues
- Meet and sustain productivity and quality metrics determined by management.
- Other duties as assigned.
EDUCATION
- High school diploma or equivalent work experience required.
EXPERIENCE AND SKILLS
- 1-2 years of customer service experience required.
- Insurance knowledge preferred.
- Excellent verbal and written communication skills.
- Excellent interpersonal and customer service skills.
- Proficient with Microsoft Office Suite or related software.
- Excellent time management skills with a proven ability to meet deadlines.
- Strong analytical and problem-solving skills.
- Ability to function well in a high-paced and at times stressful environment.
POSITION COMPETENCIES
- Accountability
- Communication
- Customer Service Orientation
- Functional/Technical Skills
- Quality Focus
- Time and Task Management
PHYSICAL DEMANDS
- This is standard desk role requiring extended periods of sitting and computer work.
WORK ENVIRONMENT
- Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.