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Company: Universal Health Services, Inc.
Location: Mcallen
Posted on: March 8, 2023

Job Description:


Job Summary: The Care Advocate is a dedicated health care professional who compassionately and quickly advocates for our member's care through educating members and providers of the benefit plans, scheduling member appointments, navigating bills, and arranging transportation for Medicare lines of business.

Job Duties/Responsibilities:

  • Accountable for gaining and keeping up-to-date with the detailed knowledge of member health plans and effectively communicating benefits, plan coverage and procedures to members, and providers.
  • Receives inbound calls from members, providers or any internal/external source as needed to resolve an issue
  • Make outbound calls to respond to customer inquiries (telephonically or email), providing information about member plans and services, and resolving customer issues
  • Guides members with their healthcare needs byexplaining benefits, solving claim concerns, helpingfind a doctor, setting medical appointments, coordinating Medicare member transportation to provider officesthrough telephone, online chats or e-mails.
  • Responsible for developing and maintaining a strong rapport with members and providers through active listening, empathy and compassion when resolving questions, problems or complaints.
  • Meets call tracking production standards to assure a timely response and single contact resolution where possible.
  • Documents all inquiries (100%) and complaints (100%) in Customer Tracking Software to assure timely response and closure; identify trends in specific areas for improvement and opportunities for communication and education to the Manager of Member Service Representatives.
  • Research provider bills looking for member liability and discrepancies pertaining to wrongful charges.
  • Responsible for sending member notifications communicating primary care provider terminations in a timely manner.
  • Works with the Manager of Member Service to modify, develop and update existing procedures and/or methods within the department to improve productivity.
  • Works closely and effectively with other areas to the Health Plans Division to resolve specific member problems or concerns.
  • Partners with internal departments to create a seamless experience for members and providers to resolve potential issues.
  • Promotes good public relations for Health Plans Division and maintains member and/or employee confidentiality and professionalism at all times.
  • Maintains all Compliance and HIPAA regulations at all times Requirements:
    • Minimum High school Diploma, AA degree preferred
    • Basic understanding of medical and health care terms and processes preferred.
    • Strong communication skills both written and verbal.
    • Positive customer service skills including active listening, empathy and compassion when resolving member and provider questions, problems or complaints
    • Resourceful, good problem solving abilities, attention to detail, and teamwork orientation.
    • Technical proficiency as it relates to software navigation, web-based program organization, and a clear understanding of office program.
    • Flexibility to meet the changing demands of the business.
    • Ability to be present, complete any task assigned, consistently do the right thing, work together toward the business goals
    • Appetite for growth, learning and working in a fast-paced, challenging environment.
    • Ability to learn new lines of business, software, platforms and methods for processing member and provider service requests.

Keywords: Universal Health Services, Inc., McAllen , CARE ADVOCATE, Other , Mcallen, Texas

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