Care Guide Advocate

About The Role The Care Guide Advocate is an integral hybrid role supporting both the RN Care Coordinators and the Utilization Management RNs. This member will fulfill key patient experience responsibilities by assisting with the navigation process for members, providers, and digital vendors to fulfill key functions and duties for the medical teams at Evry. They will effectively leverage a myriad of skill sets to provide the member and/or provider with a seamless experience by blending administrative, educational and customer service functions. About Evry Health and Globe Life We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE: GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company. Roles & Responsibilities Provide a high degree of customer service and professionalism when interacting with the patients of providers via the phone or email; ability to empathize and diffuse difficult situations professionally and in a caring manner Assist members with detailed provider searches utilizing network look-up tools Assist members navigating our digital programs and serve as a conduit for escalations and questions Contact provider offices or facilities to obtain needed prior authorization pieces such as additional medical records, forms, facility location or Tax ID numbers for claims billing Assist with claims work such as adjusting site of service Protect/observe patient privacy and confidentiality, per external regulatory requirements (HIPAA) and internal policy and procedures Ensures compliance with applicable URAC and NCQA accreditation guidelines and state and federal regulations Minimum Qualifications High school diploma 2-3 years in customer service Strong computer skills and experience with electronic medical records Intermediate knowledge of Microsoft Windows Exceptional verbal and written communication skills Ability to work effectively and flexibly in a fast-paced environment with competing priorities Preferred Qualifications Experience in health insurance plan. Experience with medical office/customer support. Associate’s degree in medical field. Work Environment This is a fully remote position. Candidates must reside in the United States within the Central (CST) or Eastern (EST) time zone. Standard business hours are Monday through Friday, 9:00 AM – 5:00 PM CST, with occasional flexibility required to meet regulatory response deadlines. Must maintain a dedicated, private workspace that is separate from other living areas and supports the secure handling of confidential information. Must have a reliable high-speed internet connection. All company-sensitive documents must be kept secure and handled in accordance with Evry Health data privacy and security policies.