Personal Health Advocate

This is a fully remote position, open to applicants in United States.

📋 Description

• Handle incoming calls from members regarding healthcare concerns, such as infertility, chronic illnesses, medications, and diagnoses.

• Evaluate member requirements and identify suitable actions while adhering to policies, procedures, and key performance indicators (KPIs).

• Take responsibility for member cases and promote ongoing engagement.

• Inform members about medical conditions, diagnostic tests, test outcomes, and treatment possibilities.

• Articulate complex medical and benefit information in a clear and compassionate manner.

• Cultivate trusted relationships that encourage member involvement in healthcare decisions.

• Offer healthcare provider and service alternatives based on clinical necessities, location, and benefit coverage.

• Investigate providers through credentialing, educational verification, and affiliations with medical centers.

• Facilitate communication between members, physicians, and insurance providers.

• Assist with scheduling appointments, transferring medical records, resolving access issues, ensuring benefits, managing prescriptions, negotiating fees, and addressing authorization challenges.

• Keep accurate and timely documentation in approved systems.

• Make outbound follow-up calls and respond to delegate box, answer service, and after-hours calls as needed.

• Appropriately escalate cases to supervisors or internal clinical resources.

• Remain informed about patient-care procedures, diagnoses, authorizations, denials, and healthcare practices.

• Mentor and assist new team members.

• Work collaboratively with colleagues to uphold service excellence and maintain balanced workflows.

• Build professional relationships with both internal and external customers.

• Collaborate with team members to achieve departmental objectives.

• Provide customer service that surpasses expectations.

• Elevate workflow or communication issues to leadership as necessary.

⛳️ Requirements

• Bachelor's of Science in Nursing (BSN) or Registered Nurse (RN) degree from an accredited institution (required).

• Active and unrestricted State or Multi-State Registered Nurse license (required).

• At least 3–5 years of clinical and/or medical management experience.

• Prior experience in behavioral and/or mental health is highly preferred.

• Strong comprehension of medical terminology and healthcare systems.

• Exceptional verbal communication skills and a professional phone demeanor.

• Ability to clarify complex healthcare topics to a diverse audience.

• Highly proficient listening, problem-solving, and issue-resolution abilities.

• Strong organizational and administrative skills.

• Proficient in Microsoft Word and Excel.

• Capability to work effectively in a collaborative, remote team setting.

• Ability to thrive in a fast-paced, high-volume call environment.

• Skill in maintaining organization, thorough documentation in real-time, and following cases through to resolution.

• Dedicated HIPAA-compliant workspace with stable internet connectivity.

• Ability to endure prolonged sitting, continuous use of computers and phones, repetitive motions, typing, concentration, reading, and ongoing verbal and written communication.

🏝️ Benefits

• Comprehensive training provided to ensure job proficiency.

• Opportunities for professional growth and advancement within the company.

• Fully remote work arrangement available.

• Requirement for a dedicated HIPAA-compliant workspace.

• Reasonable accommodations may be available for individuals with disabilities.