Member Experience Specialist

Company :

Job Description : 

JOB SUMMARY

This job provides personalized support and guidance to customers through an omni-channel experience, leveraging knowledge of healthcare administration and integrated partnerships to proactively resolve inquiries, ensuring a positive and seamless experience and ultimately driving positive member behavior and cost-effective business outcomes.

ESSENTIAL RESPONSIBILITIES

• Serve as the primary point of contact for customers seeking information and assistance regarding their health benefits, claims, and online healthcare tools. Resolves standard and frequently non-routine, customer inquiries, comments, and concerns with the most limited escalation consistent with company policies and processes.

• Engage and guide members through clinical model complexities; connect members with appropriate clinical and non-clinical resources and redirect member site of care as defined by model and client requirements.

• Educate members on how to optimize insurance benefits by explaining the financial impact of healthcare choices, available provider/service options, and the importance of receiving the right care at the right time and place.

• Enroll members in programs that utilize digital tools designed to enhance their healthcare journey. Provide training and support to help members navigate these tools and actively engage in their own health management.

• Other duties as assigned or requested.

EXPERIENCE

Required

• 3 years of experience in customer service, healthcare administration, or related field

• Experience working with Highmark health plans and customer service systems

Preferred

• None

SKILLS

• Ability to apply in-depth product knowledge of health plan offerings

• Proficiency in using and navigating customer service systems specific to Highmark health plans     

• Strong communication and interpersonal skills, with a focus on empathy and active listening     

• Ability to work independently and as part of a team      

• Proficiency in Microsoft Office Suite and other relevant software applications

• Ability to maintain confidentiality and adhere to HIPAA regulations

EDUCATION

Required

• None

Substitutions

• None

Preferred

• Associate's degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.   

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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