Job Description:

Job Summary:

The role of the Family Health Advocate Lead is an exciting and innovative remote role newly created to provide meaningful support to both Family Health Advocates who provide support to members and their families through personalized resource and referral facilitation, issue resolution and healthcare navigation and the members themselves to achieve their health goals, reduce costs and optimize quality care.

Essential Job Functions:

• Answer inquiries from members (via voice and chat) for the following:

• Help with eligibility, benefit education, open enrollment / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, dental, and vision plans

• Provider search (PCP, specialty, and facility), focused on healthcare cost and quality, and present premier provider options, including but not limited to medical, dental, and vision plans

• Support for spending accounts, pharmacy, and disability.

• Assistance with incentives and rewards

• Aid with ordering durable medical equipment (DME)

• Community resource search

• Member preferences management

• Coordinate issue resolution with providers, payers or 3rd parties for:

• Claims adjustments

• Grievances and appeals submissions

• Utilization management intake or status

• Complex pharmacy inquiries

• Complex spending account inquiries

• Provide proactive care guidance for various value-add opportunities:

• Guidance on closing care gaps (e.g., No PCP, discussing switching from low quality PCPs to high quality PCPs, reminder for completion of health risk assessment, reminders for exams/tests due)

• Proactive benefits education for procedures

• Preparing members for scheduled procedures/admissions

• Referring members to available 3rd parties for care management and second opinion.

• Referring members to Clinical Advocates (Nurse) for conditions that require clinical care and case management assistance

• Primary duties include but are not limited to:

• Understands and communicates the benefit design packages to members as defined by employer.

• Interacts with members verbally and in written form to ensure appropriate engagement is achieved.

• Is fully versed in and can explain plan benefit design, handles benefit and enrollment issues.

• Drive member's engagement into appropriate programs and offerings.

• Be an educator on health care related inquiries.

• Support Family Health Advocates in answering member inquiries by educating to and reinforcing department processes providing first level support and guidance.

• Coordinate with leadership when they identify process or other business gaps to implement resolution.

• Set the example with subject matter level understanding of the Advocacy Industry (payers/employer benefits).

• Intake member escalations when Family Health Advocate is unable to provide adequate level support to member.

• 50% of time on phone support and 50% of time Family Health Advocate Support

Specific Skills/ Attributes:

• Excellent multi-channel communication and problem-solving skills

• Ability to communicate effectively in both voice and chat channels, including critical thinking skills, effective typing, grammar, and spelling skills.

• Proficiency in payer and employee benefit administration and configuration.

Qualifications:

• High school / GED diploma

• 2-yr associates degree in healthcare/health sciences OR equivalent experience in healthcare, preferably helping members navigate benefits and claims, OR held one or more of the following positions:

• Patient Health Guide/Advocate/Navigator

• Patient Care Technician (PCT)

• Medical Secretary/Clinic Manager

• Medical Coder

• Claim Specialist

• Health Care Administration

• Benefit Specialist

• Experience in Advocacy Support center, healthcare contact center, provider office, or healthcare institution

• Experience in successful resolution of high level/sensitive customer service issues.

Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law.

Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor.