Member Advocate

Position Summary

This employee will be responsible for all plan member communications in the Allied Advocate Department. Employee will work with plan members throughout the process starting with patient letter and finishing with call to explain final resolution. Communication may be in written or verbal form.

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 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

• Communication
• Customer Focus
• Accountability
• Functional/Technical Job Skills
  
  

PHYSICAL DEMANDS

• This is an office environment requiring extended sitting and computer work.
  
  

WORK ENVIRONMENT

• Remote
  
  

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 & 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.