Customer Advocacy Representative

At Brighton Health Plan Solutions (BHPS), we’re creating something new and different in health care, and we’d love for you to be part of it. Based in New York City, BHPS is a rapidly growing, entrepreneurial health care enablement company bringing tangible innovation to the health care delivery system. Under the Brighton Health Group portfolio with the support of a premier investor group led by Goldman Sachs, our 250-person team is committed to transforming how health care is accessed and delivered. We believe that cost, quality, and population health are optimized when people have long term relationships with their health care providers – and that’s why we’re creating new products that today do not exist anywhere in the New York/New Jersey market. With a growing labor business under the well-known MagnaCare brand, the launch of Create – a new marketplace of health systems focused on self-insured commercial health plan sponsors, and a successful Casualty business, we’re fiercely committed to positively impacting our partners.

Company Mission:
Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision:
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

About This Role:
BHPS is looking for a Customer Advocacy Representative who is a highly skilled service representative who can handle all aspects of servicing members and providers. The Customer Advocacy Representative is an advocate and educator of customers to provide a superior level of customer service. The Customer Advocacy Representative services members, providers and clients with a variety of technology tools that most health plans do not offer.

Primary Responsibilities:

• Performs customer advocacy services assisting members with navigating their benefits and services; locating healthcare providers, scheduling appointments and resolving billing issues.
• Provides advocacy resources to non-covered family members including guidance with Medicaid, Medicare, transportation and Hospice care.
• Utilizes the Create Member Portal as the primary tool to navigate most service issues.
• Address members in a courteous, friendly, compassionate and professional manner.
• Listens attentively to member needs and concerns; demonstrates empathy to gain a comprehensive understanding of all factors impacting the member and assist in resolving any issues.
• Meet member requirements through first contact resolution, where possible.
• Use decision-support tools to answer questions, where needed.
• Solve problems that are sometimes unstructured and that may require reliance on conceptual thinking.
• Offer solutions to issues that are often non-standard/non-routine and require some clarification.
• Confirm member understanding of the solution and provide additional member education as needed.
• Prepare complete and accurate work and thoroughly documents member events in the Impact transaction system.
• Communicate effectively with colleagues in other departments to ensure high quality and timely expedition of member requests.
• Customer Advocacy Representative monitors ongoing service events and communicates any concerns where guidance isn’t available for developing additional resources.
• Reports any observed trends in calls to leaders for process improvement initiatives and to improve member satisfaction.
• Maintains extensive knowledge of Create products, benefits, standard operating procedures and services.
• Effectively communicate effectively with the member about Create utilizing FAQs, job aides and SOPs in navigating issues.
• Encourages members and providers to self-service on the Create member and provider portals. The Customer Advocacy Representative also promotes the use of the MyCreateHealth app for smartphones and tablets

Essential Qualifications:

• Bi-lingual English and Spanish or Russian or Mandarin or Cantonese preferred but not required.
• Prior experience in a call center or provider practice preferred.
• Knowledge of medical terminology is preferred.
• Previous experience in a concierge service organization and/or healthcare background.
• Fluent in technology solutions including on-line appointment scheduling, click to chat, click to call, click to email.
• Strong skills in Microsoft Office, Outlook, Excel, Word, Adobe.
• Professional verbal and written communication skills, and the ability to clearly articulate thoughts and ideas
• Ability to handle multiple tasks and/or projects at one time and work in a fast-paced environment.
• Ability to effectively communicate through multiple channels—specifically email and chat in addition to voice.
• Previous multi-channel experience (i.e. voice, email, and chat) a plus.
• We are an Equal Opportunity Employer