• 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) • Build relationships with members in order to collaborate and develop plans of action by going above and beyond members’ initial requests • 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 • Document cases in the department’s case management system using approved processes and procedures • 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 • Mentor new team members

• Assists clients in reporting claims to carriers, advise on managing emergency services and how to begin documenting the claim. • Consider and advise client on any other resources such as restoration firms, engineering consultants or claim preparation services. • Assist clients with managing cash flow by advocating for early advance payments and ongoing partial payments as desired by the client. • Throughout the process anticipate potential issues and communicate to the client and the adjustment team. • Provide advice and guidance on carrier coverage positions. • Advocate for client in response to any adverse coverage position. • Manage client claims to bring about timely and fair settlement by appropriate follow up activities and settlement negotiations. • Provide input to Risk Solutions placement team on client claims status as requested. • Provide feedback to the placement team on any identified coverage issues or concerns. • Develop Service Plans for claims handling based on client needs. • Support and strengthen the Practice through individual contributions and suggestions, mentoring and coaching of junior team members inside and outside the Practice, communicating of success stories to our internal team and to clients as appropriate. • Provide assistance and support for new business development/RFPs. • Develop and maintain relationships with clients, independent adjusters and vendors for the benefit of our clients. • Keep current on marketplace changes. • Attend required training sessions, courses, etc. to develop and maintain up-to-date skills and maintenance of your broker’s license. • Maintain appropriate level of confidentiality of information processed. • Follow all company policies and procedures. • Other duties as assigned.

• supports customers by providing operational excellence and a deep commitment to ensuring simple and transparent experiences • responsible for delivering population health program analytics • supporting client implementations and ongoing program execution • providing support for member engagement

• Inbound and outbound calls to members and providers to help getting services like healthcare visits, screenings, vaccinations, or medication refills. • Working through barriers that stand in the way of our members’ good health • Delivering the best member experience through professional empathetic conversations • Provide important education to members to help them make good health decisions that improve their health • Accurately document conversations in the member’s health record