Member Experience Advocate

Overview

6 Degrees Health is a healthcare cost containment company dedicated to achieving superior results while prioritizing a best-in-class customer and member experience. We leverage both clinical expertise and innovative technology to deliver fair reimbursements and enhance payment accuracy.We are currently seeking a Member Experience Advocate to join our fun, fast-paced environment.

Role Summary

Due to the anticipated growth, 6 Degrees Health is looking for the right candidate to join our team as a Member Experience Advocate in a remote working environment.This role’s main purpose is to deliver compassionate service to our members byactively listening to their concerns, taking actions to help resolve their issues, educating them on RBP(Reference Based Pricing) and expectations of the resolution process along with providing timely updates. This position also includes answering inbound calls and setting the rest of the 6 Degrees Health team up for successwith detail-oriented case creation.The ideal candidate will be highly empathetic,organized and passionate about advocating for our members by providing world-class customer service. This is a remote position based in the United States.

Essential Role Responsibilities

• Foster a culture aligned with 6DH values
• Assist members with solving problems with their claims, access issues, or other concerns related to their Health Plan.
• Advocate for members when they need a healthcare provider who will accept their Health Plan.
• Educate members on RBP and what to expect when an access issue or balance bill claim occurs.
• Promote the benefits of RBP, the importance for their employer to offer a health plan solution that reprices claims at a fair and objective rate.
• Guide members through the appeals and collection processes.
• Communicate with members throughout the resolution process to keep them updated on their cases.
• Answer incoming member calls with empathy and determine appropriate course of action to help resolve their case.
• Demonstrate confidence in industry knowledge when communicating with our healthcare partners such as, medical providers, brokers and TPAs.
• Utilize de-escalation techniques in times of member frustration through continued support, education, and empathy.
• Follow all standard operating procedures including creating new cases, proactively managing cases, completing member outreach within 24 hours upon a new case and updating members timely.
• Determine when a member’s case needs to be prioritized over others and knowing when to escalate to management.
• Adhere to patient confidentiality requirements and other company policies.
• Work in conjunction with others on the Operations Team to ensure the satisfaction of both Health Plan and members, resulting in retention.
• Partner with management to design, update, and/or improve standard operating procedures.
• Actively participate in all team meetings.
• Other responsibilities or projects as assigned.

Minimum Role Requirements

• Listening skills to understand what the members’ needs are so that their concerns are addressed appropriately.
• Communication skills to work with members on a variety of claims situations.
• Compassionate attitude to give emotional support to members during stressful situations.
• Excellent project and time management skills.
• Proven organizational and prioritization skills with an ability to operate in ambiguous situations.
• Demonstrates ability to quickly learn to adapt new ideas and processes.
• Ability to maintain accuracy and efficiency standards consistently.
• Ability to effectively adapt in a dynamic environment.
• Must have the ability to read and understand various procedural documentation.
• Ability to interpret patient records and calculations while maintaining strong attention to detail.
• Strong internal and external communication skills, both verbal and written.
• Must be able to manage inbound calls with confidence and compassion.

Required Skills

• Desire to be helpful
• Effective communication skills
• Ability to de-escalate a situation effectively
• Knowledge in the Healthcare industry
• Problem solving
• Must be able to operate computers and phones to support position requirements
• Strong Microsoft Office Skills a must, must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary
• Must be able to sit or stand for two hours at a time

Essential Role Functions

• Strong internal and external communication skills, both verbal and written
• Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary
• Must be able to sit or stand for two hours at a time
• Must be able to operate computers and phones to support position requirements
• Strong Microsoft Office Skills are a must

Education

• High School Diploma or equivalent required
• College Degree or equivalent work experience preferred

Experience

• 3+ years customer service experience required
• Healthcare background strongly preferred but not required

Organizational Benefits

• Medical, Dental, Vision and Other Outstanding Ancillary Benefits
• Training and Development Opportunities
• Paid Holidays
• 401k Program
• Remote Work Stipend
• Unlimited Paid Time Off
• Calm App Premium Membership

Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa.

The base salary range for this position is between $42,000 and $45,000, plus benefits. Please note that the base salary range is a guideline, and that individual compensation will vary based on factors such as overall qualifications, skillsets, competencies, and work location.

At 6 Degrees Health, we understand that an outstanding team is the building block of any organization. With a solid foundation, achieving our goals becomes a reality. We are dedicated to creating a safe and inclusive environment for our employees, and those in our communities, and we believe that our community is stronger when everyone is included and appreciated. We are committed to learning, listening, and improving, while celebrating the diversity and humanity of all people. We are committed to providing opportunities for engagement in decision making and ensuring safe transparency to express and challenge ideas.

6 Degrees Health, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.