Job Description

Montage Health’s application process has changed effective 12/20/2019.
If you submitted an online application prior to 12/20/2019, you will be required to recreate your profile information if you want to apply to any new positions. You will no longer have access to your previously saved profiles and applications. Current employees applying for transfer into a posted position must also create a profile.

  • Excellent Pay and Generous Benefits including a Pension and Continuing Education Reimbursement
  • Excellent Team Orientated Culture
  • Free Gym for Employees

Job Description:

Purpose of Position

The Member Services Advocate will have an extensive knowledge of the company’s processes and procedures and is the single point of contact at Aspire Health Plan for members referred. The position will act as an advocate for the member and a liaison between the Health Plan and providers to ensure availability and access to care.


The Member Services Advocate ensures member satisfaction by developing and maintaining a productive relationship and interaction with members, while providing personalized and consultative education and information. This person will develop a personal relationship with members, advocating for their access to local services and resources and providing superior customer service. We are looking for an individual with passion for excellent customer service and improving the health of the senior population.

This position reports to the Health Plan Operations Manager, but will also provide support to the Member Relationship Manager and collaborate with department staff across the organization.

Responsibilities

  • Help orient and educate members about accessing care and managing their health and well-being by maximizing the value of their health plan benefits and seeing their primary care provider
  • Encourages members to engage in managing their health
  • Conduct targeted phone campaigns in an effort to increase adherence to recommended preventive screenings, quality initiatives and health risk assessments; assists in related data entry and document management
  • Assist members to access to Aspire health care providers as well as community classes, social services and agencies
  • Adapts communication style to persons representing diverse personal, professional, cultural, and socio-economic backgrounds
  • Facilitate the collection and transfer of medical records as needed
  • Arrange health care services for members
  • Contact providers on member’s behalf to coordinate care
  • Works to remove barriers to care, either at the provider or member level
  • Respond to inquiries from members, providers and delegated entities, providing superior product and benefit information
  • Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
  • Develop ongoing relationships with members, encouraging retention
  • Conduct member interactions through multiple channels such as telephone, email, online chat and mobile phone/text
  • Subject matter expert on Plan products, benefits, and network providers to answer member questions regarding benefits, eligibility, referrals, claims and any other member service issues that may arise during outreach calls
  • Help plan and staff internal and external activities that promote Aspire Health Plan
  • Contribute to content for member mailings
  • Follow up with appropriate parties on status of high-risk member referrals
  • Coordinate member transactions, including but not limited to primary care physician changes, demographic changes, and membership material requests with customer service
  • Collaborate with Customer Service, Enrollment, Claims, Health Services, Pharmacy, A&G and Sales to ensure that members and provider issues are appropriately resolved
  • A willingness to help at all times, while maintaining a professional demeanor
  • Documents transactions and actions taken in appropriate systems
  • Serves as the "Voice of the Member" in internal meetings
  • Adhere to all regulatory requirements relating to member confidentiality, documentation, quality, and inquiry response time

Competencies

  • Problem Solving and Decision Making:  Identifies, analyzes, organizes, and solves problems and issues in a timely, effective manner; uses data and input from others to make sound, timely decisions even in the face of uncertainty.
  • Integrity:  Consistently honors commitments and takes responsibility for actions and words.  
  • Flexibility:  Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.
  • Inclusiveness:  The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.

Position Requirements

  • Minimum A.A. degree or equivalent practical experience in related or similar positions.
  • At least two years' experience in customer service/call center within the managed care, insurance, healthcare, or related call center environment
  • Bilingual proficiency (Spanish and English) preferred, but not required
  • Strong comprehension skills. Uses excellent hearing and listening skills to receive detailed information
  • Ability to communicate effectively, including written and verbal communication skills
  • Passion for advocating on behalf of a Medicare-eligible population
  • Ability to analyze and understand multiple health plan benefits and recommend solutions in person, via e-mail or telephonically
  • Medical benefit coordination experience preferred.
  • High level of attention to details in obtaining complete and accurate information
  • Problem resolution skills
  • Ability to key data accurately and rapidly
  • Ability to operate computer equipment and software programs necessary to fulfill position responsibilities
  • Working knowledge of Microsoft office products including Outlook, Word, and Excel
  • Ability to interact professionally with co-workers, providers, members, vendors and management-level staff.

About Aspire

Aspire Health Plan is a locally owned Medicare Advantage HMO that provides comprehensive medical coverage to seniors and other Medicare recipients in Monterey County. We’re proud to be a community-centered organization backed by Community Hospital of the Monterey Peninsula and Salinas Valley Memorial Hospital. Over 700 doctors, many other healthcare providers, and all four Monterey County hospitals are part of the Aspire Health Plan network. It’s the care you need from people you know.

Aspire Health is an equal opportunity employer.

Assigned Work Hours:

Position Type:

Regular

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online