Member Advocate Representative (Hybrid)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least once per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per month.

This position is hybrid within the state of AZ only.This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

This highly visible position provides exceptional customer service to members on a variety of health plan programs and services. Representative performs activities related to closing member healthcare and quality gaps/deficits through inbound member calls and outbound telephone member outreach, coordinating member appointments with provider offices, ensuring provider satisfaction for member and collaborating with internal and external partners to ensure member satisfaction. The position also handles member escalation where service team could not resolve the member issue(s). Requires complex multi-tasking using multiple applications to ensure the highest level of customer satisfaction and accurate reporting. Excellent communication skills required.

REQUIRED QUALIFICATIONS

Required Work Experience

• 3 years of customer service experience in a healthcare organization or a primary healthcare practitioner's office

Required Education

• High School diploma or GED in general field of study.

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• N/A

Preferred Education

• Education or training in the basics of medical terminology, medical record documentation, and common ICD, HCPCS, CPT codes

Preferred Licenses

• N/A

Preferred Certifications

• N/A

• Conducts outbound call campaigns and member focused interventions utilizing outbound call scripts and talking points.
• Receives inbound member calls on a variety of health plan programs and services. Utilizes calls scripts and talking points.
• Responds with accuracy to program, benefits, provider, pharmacy, eligibility and claims related questions or concerns.
• Handles complex or escalated member calls
• Communicates to members the importance of receiving an Annual Physical Examination and appropriate screenings from their primary care provider.
• Informs members of healthcare gaps that should be addressed by visiting their primary care provider, encourages completion of screenings and assists with scheduling when applicable.
• Works cross-functionally with internal teams including Member Services, Grievances & Appeals, and Care Management and external partners to ensure member satisfaction and member retention.
• Completes daily inbound and outbound call assignments, meets call metrics, quality improvement, and gap closure productivity standards for outreach activities.
• Supports business goals to improve Risk Adjustment, CAHPS, HEDIS and HOS scores.
• Maintains working knowledge of Medicare while adhering to health plan policies and procedures.
• Reads and responds to department communications, actively participates in staff meetings and department activities that include process improvements or team building.
• May represent the health plan at external events, health fairs and other plan educational events
• Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.

Responsibilities as Senior

• Answer questions from team members
• Support lead and/or manager with escalation issues
• Complete Medicare Advantage Coordination of Care program work as mandated by the Association.
• Lead Member Benefit Refresher seminars throughout the year. May participate in Plan Annual Notice of Change (ANOC) training during Annual Enrollment Periods (AEP).
• Lead and/or participate in business specific projects.

REQUIRED COMPETENCIES

Required Job Skills

• Computer proficiency in a MS-Windows environment, including MS Word and Excel, and ability to learn organizational systems and software applications
• Experience in performing outbound calls and receiving inbound calls from customers/members.
• Ability to multi-task and remain focused on member needs.

Required Professional Competencies

• Ability to effectively communicate with health care providers and staff, patients, and co-workers.
• Strong organizational skills
• Provides excellent customer service by consistently demonstrating the BCBSAZ core values

Required Leadership Experience and Competencies

• N/A

PREFERRED COMPETENCIES

Preferred Job Skills

• Basic knowledge and understanding of primary care provider office practices, appointment setting, medical records management, and billing processes
• Bilingual in English/Spanish

Preferred Professional Competencies

• N/A

Preferred Leadership Experience and Competencies

• N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.