Member Advocate (Customer Service Rep) - UT - OneTenCoalition
Murray, UT
About the Job
Job Description:
Select Health's Member Advocate role has the critical accountability to provide superior service directly to Select Health members, customers, and providers and to deliver on Select Health's strategy and mission. The Member Advocate position assists Select Health members in living their healthiest lives possible by educating them about the best usage of health insurance plans with participating providers.
Work from home and Flexwork opportunities available upon completion of training, phone certification process, and work requirement standards are met.
Successful candidates will receive a $1500 sign-on bonus!!
$500 paid after successfully completing basic training (60 days) and $1000 paid after successfully completing phone certification and being in the position for 6 months. *Paid out following month compensation*
Select Health has been awarded "Best Companies to Work for" seventeen times.
Member Advocate - Phones
Our training for these positions includes learning how to provide excellent customer service with incoming calls by being a knowledgeable resource, resolving disputes, maintaining confidentiality, and creating an exceptional experience for all.
The Member Advocate provides exceptional customer service to all Select Health members, employer groups, providers, facilities and other Select Health departments. You will help Select Health members in finding medical, dental, mental health providers, and give them a superior customer service experience by using multiple programs and methods of resolving their concern.
Outstanding benefits. In addition to competitive wages, you'll also enjoy great benefits, including:
In addition to competitive wages, you'll also enjoy great benefits, including:
Job Description
As part of Intermountain Health, Select Health is more than just an insurance company. We strive to provide our members with low cost insurance options and access to high quality care, while responding to all concerns in a timely manner. Our mission of excellence extends to our employees as well. Select Health has been named "Best Companies to Work For" by Utah Business magazine for seventeen years.
A Member Advocate assists in directing Select Health members to appropriate providers based on the medical and mental health needs of the patient. Providers include physicians, facilities, dentists, and other medical providers. Identifies service options for the member using specific criteria such as urgency, diagnosis, specialty, sub-specialty, provider location, and availability. Gathers information for service approval when provider gaps are identified.
We highly recommend watching the video below to gain a better understanding of the Member Advocate position as well as the working environment.
https://youtu.be/K4UH0jp1WCM?si=5-1omkKILsAjQgu-
Upon hire, we'll provide a paid in office, seven-week training and mentoring experience. Training includes learning how to provide excellent customer service with incoming calls by being a knowledgeable resource, resolving disputes, maintaining confidentiality, and creating an exceptional experience for all.
If selected to advance in the hiring process, this position will include an in office interview at our Murray, Utah office. Please review your email closely over the next week for a potential invitation from SHMemberServicesHiring@imail.org.
Entry Rate: $20.40/hour; plus a potential maximum monthly performance-based bonus of $219 shortly after training in addition to a $1500 sign on bonus paid if in position for 6 months.
Benefits Eligible: Yes - Paid time off, tuition reimbursement, medical, dental and vision insurance. Some benefits start immediately, others like medical, dental, and vision start the first of the month following start date
Shift Details: Start Date: February 24th, 2025 ( In Office Training in Murray, Utah ) Throughout the seven-week training and phone certification process employees work Monday through Friday, 8:00 a.m. to 4:30 p.m. (Full Time Schedule 40hrs/week)
Due to extensive training, time off will not be approved for the first 60 days of employment.
Post training, shifts will typically fall within regular business hours: Monday through Friday, 7:00 a.m. to 9:00 p.m., and Saturday 9:00 a.m. to 3:00 p.m.
In Office and Flexwork Options: The opportunity to work from home will be an available option after the completion of training, phone certification, and work requirement standards process. Job specific standards and a work at home conducive environment are required before making this transition. All work at home or Flexwork request will go through an approval process.
Job Essentials
1. Receives incoming calls from member, providers, facilities, employer groups, and other Select Health affiliates and departments. Triages and researches individual member situations to ensure that they are being referred to the appropriate provider, Instacare, or emergency room. Provides superior customer service that is consistent with policies, company values, quality standards, and service commitments.
2. Works with providers and facilities to prioritize and schedule appointments based on urgency of care required by members. Collects clinical and treatment information from providers in order to guide members to participating providers who can provide the appropriate level of care for their specific condition. Utilizes the PDA (Provider Database Administration) to research provider specialties, and sub-specialties in order to direct care for members requiring specialized treatment.
3. Complies with established standards for call response time, length of call, availability, and call distribution.
4. Complies with established auditing criteria for calls, service approvals, and non-participating reviews. Stays current and conversant on call guidelines to provide accurate information and NCQA compliant service. Works cases within established timelines to ensure that reviews are completed and in compliance with Select Health, NCQA, and CMS guidelines.
5. Maintains the confidentiality of members' personal information to be compliant with internal and external confidentiality policies. Maintains customer history in member tracking using correct codes and detailed comments.
6. Conversant on all Select Health plans, including covered/not covered services, experimental and investigative procedures (M Tech), as well as new plan designs, modifications and documentation updates.
7. Follows established guidelines to conduct nonparticipating provider reviews and allow service approvals for members and providers.
8. Researches and gathers information to prepare cases for nonparticipating review or service approvals, or other referral services.
9. Maintains primary care physician (PCP) assignments for Medicaid and Medicare members and ensure PCP compliance. Assigns PCP's for high utilizers on Medicaid as identified by the UM departments.
Skills
Minimum Qualifications
Preferred Qualifications
Call center experience
Bilingual in English and Spanish
Physical Requirements:
Physical Requirements
Location:
SelectHealth - Murray
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$20.40 - $20.40
We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
Select Health's Member Advocate role has the critical accountability to provide superior service directly to Select Health members, customers, and providers and to deliver on Select Health's strategy and mission. The Member Advocate position assists Select Health members in living their healthiest lives possible by educating them about the best usage of health insurance plans with participating providers.
Work from home and Flexwork opportunities available upon completion of training, phone certification process, and work requirement standards are met.
Successful candidates will receive a $1500 sign-on bonus!!
$500 paid after successfully completing basic training (60 days) and $1000 paid after successfully completing phone certification and being in the position for 6 months. *Paid out following month compensation*
Select Health has been awarded "Best Companies to Work for" seventeen times.
Member Advocate - Phones
Our training for these positions includes learning how to provide excellent customer service with incoming calls by being a knowledgeable resource, resolving disputes, maintaining confidentiality, and creating an exceptional experience for all.
The Member Advocate provides exceptional customer service to all Select Health members, employer groups, providers, facilities and other Select Health departments. You will help Select Health members in finding medical, dental, mental health providers, and give them a superior customer service experience by using multiple programs and methods of resolving their concern.
Outstanding benefits. In addition to competitive wages, you'll also enjoy great benefits, including:
In addition to competitive wages, you'll also enjoy great benefits, including:
- In-office, work from home/Flexwork, or hybrid (3 in-office/2 home) work environment opportunities after initial in office training, phone certification, and work requirement standards process. All work at home or Flexwork request will go through an approval process.
- $1500 sign-on bonus
- Monthly incentives
- Referral bonuses
- Paid time off and holidays
- Medical, Dental, and Vision insurance
- 401(k) retirement savings program with an employer match
- Tuition reimbursement
- Energetic culture
- Employee wellness program
- On-site gym, online wellness classes including fitness, stretching, and mindfulness workshops
- Monthly wellness webinars
- Annual employee appreciation week
- Casual in-office dress code
- Annual 5k
- On-site café and nearby walking paths
Job Description
As part of Intermountain Health, Select Health is more than just an insurance company. We strive to provide our members with low cost insurance options and access to high quality care, while responding to all concerns in a timely manner. Our mission of excellence extends to our employees as well. Select Health has been named "Best Companies to Work For" by Utah Business magazine for seventeen years.
A Member Advocate assists in directing Select Health members to appropriate providers based on the medical and mental health needs of the patient. Providers include physicians, facilities, dentists, and other medical providers. Identifies service options for the member using specific criteria such as urgency, diagnosis, specialty, sub-specialty, provider location, and availability. Gathers information for service approval when provider gaps are identified.
We highly recommend watching the video below to gain a better understanding of the Member Advocate position as well as the working environment.
https://youtu.be/K4UH0jp1WCM?si=5-1omkKILsAjQgu-
Upon hire, we'll provide a paid in office, seven-week training and mentoring experience. Training includes learning how to provide excellent customer service with incoming calls by being a knowledgeable resource, resolving disputes, maintaining confidentiality, and creating an exceptional experience for all.
If selected to advance in the hiring process, this position will include an in office interview at our Murray, Utah office. Please review your email closely over the next week for a potential invitation from SHMemberServicesHiring@imail.org.
Entry Rate: $20.40/hour; plus a potential maximum monthly performance-based bonus of $219 shortly after training in addition to a $1500 sign on bonus paid if in position for 6 months.
Benefits Eligible: Yes - Paid time off, tuition reimbursement, medical, dental and vision insurance. Some benefits start immediately, others like medical, dental, and vision start the first of the month following start date
Shift Details: Start Date: February 24th, 2025 ( In Office Training in Murray, Utah ) Throughout the seven-week training and phone certification process employees work Monday through Friday, 8:00 a.m. to 4:30 p.m. (Full Time Schedule 40hrs/week)
Due to extensive training, time off will not be approved for the first 60 days of employment.
Post training, shifts will typically fall within regular business hours: Monday through Friday, 7:00 a.m. to 9:00 p.m., and Saturday 9:00 a.m. to 3:00 p.m.
In Office and Flexwork Options: The opportunity to work from home will be an available option after the completion of training, phone certification, and work requirement standards process. Job specific standards and a work at home conducive environment are required before making this transition. All work at home or Flexwork request will go through an approval process.
Job Essentials
1. Receives incoming calls from member, providers, facilities, employer groups, and other Select Health affiliates and departments. Triages and researches individual member situations to ensure that they are being referred to the appropriate provider, Instacare, or emergency room. Provides superior customer service that is consistent with policies, company values, quality standards, and service commitments.
2. Works with providers and facilities to prioritize and schedule appointments based on urgency of care required by members. Collects clinical and treatment information from providers in order to guide members to participating providers who can provide the appropriate level of care for their specific condition. Utilizes the PDA (Provider Database Administration) to research provider specialties, and sub-specialties in order to direct care for members requiring specialized treatment.
3. Complies with established standards for call response time, length of call, availability, and call distribution.
4. Complies with established auditing criteria for calls, service approvals, and non-participating reviews. Stays current and conversant on call guidelines to provide accurate information and NCQA compliant service. Works cases within established timelines to ensure that reviews are completed and in compliance with Select Health, NCQA, and CMS guidelines.
5. Maintains the confidentiality of members' personal information to be compliant with internal and external confidentiality policies. Maintains customer history in member tracking using correct codes and detailed comments.
6. Conversant on all Select Health plans, including covered/not covered services, experimental and investigative procedures (M Tech), as well as new plan designs, modifications and documentation updates.
7. Follows established guidelines to conduct nonparticipating provider reviews and allow service approvals for members and providers.
8. Researches and gathers information to prepare cases for nonparticipating review or service approvals, or other referral services.
9. Maintains primary care physician (PCP) assignments for Medicaid and Medicare members and ensure PCP compliance. Assigns PCP's for high utilizers on Medicaid as identified by the UM departments.
Skills
- Call Center
- Time Management
- Prioritization
- Customer Service
- Ability to Work Under Pressure
- Group Problem Solving
- Communication
- Active Listening
- Typing
- Navigation
Minimum Qualifications
- Demonstrated customer service experience
- Demonstrated ability to provide superior customer service.
- Demonstrated ability to listen and communicate effectively.
- Demonstrated ability to problem solve and work under pressure.
- Demonstrated proficiency in navigating computer systems, typing, technologies.
- Ability to multi-task, set priorities and manage time effectively.
Preferred Qualifications
Call center experience
Bilingual in English and Spanish
Physical Requirements:
Physical Requirements
- Interact with others requiring the employee to communicate information.
- Operate computers and other office equipment requiring the ability to move fingers and hands.
- See and read computer monitors and documents.
- Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment
Location:
SelectHealth - Murray
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$20.40 - $20.40
We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
Source : OneTenCoalition