Member Service Advocate, Public Plans

Overview

Who We Are
Point
32

Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point
32

Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are.

We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

Job Summary
At Point
32

Health, we’re driven by a shared purpose: to lead and empower healthier lives for everyone. Our colleagues are deeply committed to giving back to the communities where they live and work, and we’re looking for team members who want to be part of something bigger—an organization that values compassion, collaboration, and impact.

• Inbound Call Management
  - Handle inbound calls from members with professionalism and attentiveness, addressing inquiries related to health insurance benefits, coverage, claims and eligibility.
• Health Care System Navigation
  - Support and advocate for members to ensure that they receive the care/support needed.
• Problem Resolution
  - Provide education and guidance to members about their Point
  32
  
  Health benefits and take ownership of each call to ensure that issues are resolved promptly and accurately. Follow up with members as needed to ensure complete resolution.
• Member Engagement
  - Assist members in understanding and accessing their benefits and educate members on how to use self service tools, deliver proactive/anticipatory service.
• Documentation and Reporting
  - Record call details and member interactions in the system accurately, ensuring that all relevant information is documented for future reference and reporting, ensuring HIPAA, State and Federal regulations and confidentiality standards are met.
• Team Collaboration
  - Work collaboratively with other team members and departments to address complex issues and ensure a seamless member experience.
• Member Experience
  - As a brand ambassador for Point
  32
  
  Health, go above and beyond to ensure member satisfaction, proactively identifying and addressing needs and concerns.
• Continuous Improvement
  - Represent the voice of the customer by contributing to continuous improvement initiatives and providing feedback on member interactions and suggesting process enhancements.
• Metrics & Goals
  - Adhere to assigned schedules to ensure appropriate phone queue coverage and meet or exceed department established key performance indicators.
• Member Retention & Outbound Campaigns
  - Execute outbound calls to improve the member experience and assist in member retention.
• Compliance and Policy Adherence
  - Ensure all interactions are HIPAA compliant and adhere to state and federal regulations.
• Other duties as assigned.

• Required:
  
  Associate degree or equivalent work experience
• Preferred:
  Bachelor’s degree or equivalent work experience preferred.

• 0-2 years of relevant experience.

• Customer service experience in health care, call center or corporate office.
• Knowledge of medical terminology.
• Prior experience training and working in a virtual/remote setting.

• Customer Service Expertise
  - Demonstrated ability to provide exceptional service, including active listening, empathy, and clear communication with members.
• Empathy
  - Ability to put yourself in someone else’s shoes and demonstrate compassion.
• Product Knowledge
  - Strong understanding of health insurance products, policies, and industry regulations, or the ability to quickly learn and apply new information.
• Problem-Solving/Critical Thinking Skills
  - Adept at identifying issues, analyzing information, and providing effective…