Job Description

The Member Buddy is a single point of contact for members for all things related to the health plan. An Advocate assists members navigate the health plan and executes activities such as (but are not limited to); find quality doctors, schedule appointments, communicate with internal and external partners (case managers, providers, claims etc), resolve member issues.

Provide inbound and outbound communication and develop a relationship with members to ensure and facilitate effective successful outcomes:

  • Provide excellent customer services
  • Exceed member expectations creating a memorable favorable experience
  • Use critical thinking skills, organize and prioritize tasks efficiently
  • Educate members on wellness programs to better manage a health condition or disease
  • Conduct member interactions through multiple channels such as telephone, email, online chat and mobile phone/test
  • Actively listen to identify and assess member needs and take action to satisfy those needs
  • Solve problems systematically, using sound business judgment resulting in a win-win outcome
  • Complete documentation in electronic medical record and claims systems
  • Excellent interpersonal, written and verbal communication skills
  • Ability to excel in a fast-paced multi-tasking environment


Ensure members need, challenges and outcomes are being met and documented:

  • Review assigned members profiles and any Plan of Care
  • Complete any necessary paperwork and facilitate the processing (prior auth requests, case management referrals, bill problems, pharmacy issues etc)
  • Coordinate authorizations after the initial 7-day authorization has expired.
  • Obtain all medical information needed for determination and forward to clinical reviewers when criteria is not met

Qualifications:

  • High School Diploma / GED
  • Associates degree or higher preferred
  • At least two (2) years of customer service experience preferred
  • At least one (1) year health plan experience preferred
  • Knowledge of MedMC and Care Radius preferred
  • Knowledge of Medicare and Medicaid regulations and guidelines
  • Intermediate computer skills (Excel, Word, Lotus notes)
  • Excellent written and verbal communication skills
  • Effective time management skills
  • Superior Customer Service skills
  • Work cooperatively, positively, and collaboratively in an interdisciplinary team
  • Work respectfully and positively with members and providers
  • Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
  • Ability to use electronic medical record and claims systems

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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