Member Advocate - Fairos

Member Advocate - Fairos

The OccuNet Company is an innovative company striving to reduce the cost of healthcare. We are a passionate group of people that care about affordable access to healthcare without sacrificing experience. We strive to make healthcare more intelligent, streamlined, and cost-effective. We offer industry-leading capabilities on negotiations-driven levers to contain rising healthcare costs while taking an experience-centric approach improving the health and well-being of those we serve. We pride ourselves on our tight knit culture based on the 'outward mindset' philosophy, emphasizing empathy, mutual respect, and seeing each other as "whole people." We have an ambitious vision and are growing quickly. We are seeking team members who are excited about our growth, seeking to thrive in a fast-paced environment, and enthusiastic about developing their skills and career alongside us.

Job Summary

As a Member Advocate, you will serve at the forefront of The OccuNet Company's experience-centric approach, improving the health and well-being of members. You will utilize your interpersonal abilities to provide members with exceptional support by delivering high-quality, professional, and efficient service across multiple channels. You will also liaise with members and providers to resolve inquiries related to medical claims processing.

What It's Like to Work Here

At OccuNet, you matter like we matter! Our team members share a positive attitude, an outward mindset, problem-solving abilities, and patience, enabling them to provide excellent customer service even during challenging situations. Our culture, plus continuous opportunities for growth, has resulted in an industry-low turnover rate. Don't miss out on this rare opening with us!

A Day in the Life

The Member Advocate is responsible for all phone intake for the Fairos line of business. This phone inquiries can include, but are not limited to : balance billing situations, member plan education, member physician or facility access issues, and claim-related billing questions. The Member Advocate will intake all member and provider information and keep appropriate workflows (balance bill issues or general questions) or input work for triage out to external teams including Care Navigation. Member Advocates are responsible for providing members with timely communication on their billing issues and will maintain their work queue and member outreaches at the appropriate Service Level Agreement standards. The team member is also responsible for making outbound calls as needed to provider, client, and TPA partners in order to gather appropriate information or submit requests as needed to reach a timely resolution. Member Advocates will also attend various meetings and training sessions in order to stay fully capable and up-to-date on job roles and responsibilities.

Duties & Responsibilities

• Uphold best-in-class member experiences by owning the end-to-end resolution process, which includes thoughtfully guiding members throughout their healthcare journey.
• Practice TOC's "outward mindset" philosophy through providing empathic support to members, remaining conscious of their unique situations.
• Educate members on navigating TOC's healthcare plans.
• Liaise with and support members to coordinate their health plan needs, such as answering billing questions and providing plan education.
• Work with providers on behalf of members to resolve payment-related inquiries.
• Proactively anticipate the needs of members and effectively problem solve ways to support the member experience.
• Work across cross-functional teams including Account Managers and Billing Contractors to establish processes that relieve any challenges members are facing.
• Uphold compliance standards relating to HIPAA and Department of Labor guidelines when corresponding with members or providers and maintaining documentation.
• Maintains confidentiality of sensitive information.
• Perform other duties as assigned.

Required Skills and Abilities

Culture and Opportunities

Benefits