Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are supportive and friendly. Employees have room to grow, and many of Health Advocate's supervisors are promoted from within the company. Join our award winning team! 2025: - Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner 2024: - Excellence in Customer Service Awards: Organization of the Year (Small) - Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner - Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver) As part of Teleperformance in the US, we were also named #95 in the 2024 ‘Fortune 100 Best Companies to Work For®’ in the USA by Great Places to Work (GPTW®) Position Overview At Health Advocate, we are committed to providing our customers with services that improve the health, well-being and productivity of their employees. The Personal Health Advocates are a dedicated team of Registered Nurses who assist our members in navigating the healthcare system by facilitating access to healthcare providers, health and benefit information, health services and resources and entitled benefits coverage. Essential Job Functions - Receive calls from members in regards to various healthcare issues (e.g., infertility, disease, medication, etc.) and determine best course of action/s to assist the members while adhering to established policies, procedures, and key performance indicators (KPIs) (e.g. case close targets, abandon rates, member follow up, all quality indicators, etc.) - Build relationships with members in order to collaborate and develop plans of action by going above and beyond members’ initial requests, taking responsibility for members’ case records, and encouraging members to call back with future issues/ questions. - Assist and educate members in understanding their medical conditions, associated health testing, test result interpretation, and health options available to them. - Provide members choices in medical care providers and services based on the members’ clinical needs, geographic locations and available benefit offerings. - Research providers through credentialing, education checks and affiliations with notable medical centers within the member’s plan - Facilitate communication among members, treating physicians, and insurance carriers, which may include assisting members with asking necessary health questions to physicians or clarifying insurance plan provision - Take appropriate steps on behalf of members by assisting with scheduling health appointments, re-scheduling health appointments, facilitating record and information transfers, and researching and resolving various problems as applicable - Document cases in the department’s case management system using approved processes and procedures - Escalate cases appropriately and on a timely basis to supervisor or internal resources for review as applicable - Keep up-to-date on patient care procedures which include diagnosis, pre-certification, prior authorization, pre-service and post-service denials - Continuously stay up to date on various health issues and medical procedures necessary to offer top of the line feedback to members - Intercede for the member to obtain an earlier appointment. - Help members obtain prescriptions - Help members with pre-service fee negotiations - Place outbound follow up calls for issues that cannot be resolved during the initial call - Respond to member cases in delegate box, answers and after hours calls - Mentor new team members Team Interfaces/Customer Service - Establish and maintain a professional relationship with internal/external customers, team members and department contacts - Cooperate with team members to meet goals or complete tasks - Provide customer service that exceeds customer expectation - Treat all internal/external customers, team members and department contacts with dignity/respect - Escalate work flow and communication issues to supervisor Minimum Qualifications - Education- BSN or RN degree from an accredited college or university required - Minimum three to five years clinical and/or medical management experience - Active and unrestricted State or Multi-State RN License - Understanding of medical terminology to assist in locating appropriate care options - Strong Communication skills and phone etiquette - Strong ability to explain complex issues to employees/retirees - Highly effective listening skills - Strong problem solving/issues resolution skills - Excellent customer service and customer resolution skills - Organizational and administrative skills - Experience with Microsoft Word and Excel - Ability to work in a team environment Mental and Physical Requirements- - This position is a remote position. The employee will need to have a dedicated HIPPAA compliant work space. Have access to internet and router. - The nature of the work in this position is sedentary and the incumbent will be sitting most of the time - Essential physical functions of the job include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware continuously throughout the work day - Essential mental functions of this position include concentrating on tasks, reading information, and verbal/written communication to others continuously throughout the work day Related Duties as Assigned - The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties, and responsibilities required of job incumbents - Consequently, job incumbents may be asked to perform other duties as required - Also note, that reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above - Please contact your local Employee Relations representative to request a review of any such accommodations Company Overview Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need. Learn more Health Advocate https://www.healthadvocate.com/site/ Facebook https://www.facebook.com/healthadvocateinc/ Video https://vimeo.com/386733264/eb447da080 Awards: 2025: - Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner 2024: - Excellence in Customer Service Awards: Organization of the Year (Small) - Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner - Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver) 2023: - National Customer Service Association All-Stars Award: Service Organization of the Year. - Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner 2022: - Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner - Excellence in Customer Service Awards: Organization of the Year (Small) - Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver) 2021: - Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Silver Winner - Stevie® Awards for Sales & Customer Service: Most Valuable Response by a Customer Service Team (COVID-19). Bronze Winner - Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver) 2020: - National Customer Service Association All-Stars Award: Organizations of 100 or Greater, Runner-Up - Communicator Award of Distinction: October 2019 Broker News - MarCom Awards: Gold, COVID Staycation Ideas brochure - MarCom Awards: Platinum, 2021 Well-being Calendar - Best in Biz Awards: Most Customer-Friendly Company of the Year - Medium category (Silver) VEVRAA Federal Contractor requesting appropriate employment service delivery systems, such as state workforce agencies and local employment delivery systems, to provide priority referrals of protected veterans. PAY TRANSPARENCY NONDISCRIMINATION PROVISION The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)