Experienced Healthcare Customer Service Professional and Member Advocate – Delivering Exceptional Support and Coordination in a Dynamic and Innovative Environment at blithequark

Introduction to blithequark and the Industry blithequark is a pioneering force in the healthcare payment integrity sector, dedicated to providing cutting-edge, technology-enabled services that identify and rectify improper payments, thereby ensuring the financial stability and focus of healthcare providers on delivering quality care. As a leader in the US healthcare market, including Medicare, Medicaid, and Commercial Healthcare, blithequark is committed to its mission of offering innovative payment accuracy solutions that allow clients to prioritize what matters most – quality of care and healthier lives for all. The healthcare industry is evolving rapidly, with an increasing emphasis on patient-centered care, digital health technologies, and collaborative approaches to healthcare delivery. At blithequark, we recognize the importance of staying at the forefront of these trends and are dedicated to fostering a culture of innovation, integrity, and customer satisfaction. About the Opportunity We are seeking a highly skilled and compassionate Healthcare Customer Service Member Advocate to join our team. As the primary point of contact for health plan members, you will play a vital role in coordinating and communicating between patients and medical professionals, providing benefit education, navigating referral and authorization processes, and connecting members with community resources. This is an exceptional opportunity to make a meaningful difference in the lives of our members and contribute to the success of our organization. Our ideal candidate will have a strong background in healthcare customer service, excellent communication skills, and the ability to work in a fast-paced environment. Key Responsibilities Make outbound calls to members who have indicated perceived gaps in care, ensuring timely and effective support Take inbound calls, answer questions regarding the program, and document communication with precision and care Provide comprehensive benefit education to members, explaining copays, coinsurance, deductibles, in and out of network benefits, and formularies in a clear and concise manner Schedule follow-up times for additional care coordination management and/or community resource connections, ensuring seamless support Develop and maintain professional working relationships with colleagues, healthcare providers, and other contractors, fostering a collaborative and respectful environment Conduct critical due diligence follow-ups if additional research or action is required to resolve a member's concern or complaint, demonstrating a commitment to resolution and satisfaction Enter and update all contact and activity information into our system, ensuring data accuracy and integrity Notify management of any displeasure or escalated concerns with the program, legal action, government intervention, or suggestions to improve or correct processes or documents, promoting transparency and continuous improvement Communicate with other staff/departments as necessary, ensuring effective teamwork and coordination Maintain a current knowledge of campaign regulations, policies, and procedures, as well as contract requirements and objectives, staying up-to-date with industry developments and best practices Maintain HIPAA Certification, adhering to the highest standards of confidentiality and data protection Perform miscellaneous duties as assigned in a highly professional manner, demonstrating flexibility and adaptability Essential and Preferred Qualifications To be successful in this role, you will need: At least 4 years of medical customer service experience, with a deep understanding of healthcare operations and customer needs At least 1 year of Medical claims processing and/or billing experience preferred, with knowledge of healthcare reimbursement and billing practices High School diploma or equivalent required, with a strong foundation in education and training Excellent verbal and written communication skills, with the ability to articulate complex information in a clear and concise manner Skilled in data entry and knowledge of computers, with proficiency in software applications and technology systems Courteous, professional, and respectful attitude, with a commitment to delivering exceptional customer service and support Strong understanding of customer service policies and processes, with the ability to apply this knowledge in a practical and effective way Member customer service background, with experience working in a fast-paced, dynamic environment Flexibility to handle any non-standard situations that may arise, with a calm and composed demeanor Must be able to multitask, with the ability to prioritize tasks and manage multiple responsibilities Skills and Competencies Required for Success In addition to the essential and preferred qualifications, the following skills and competencies are required for success in this role: Strong analytical and problem-solving skills, with the ability to analyze complex information and develop effective solutions Excellent communication and interpersonal skills, with the ability to build strong relationships with colleagues, healthcare providers, and members Ability to work in a fast-paced environment, with a high volume of calls and interactions, while maintaining a calm and composed demeanor Strong attention to detail, with a focus on accuracy and quality in all aspects of work Ability to maintain confidentiality and handle sensitive information with discretion and professionalism Strong organizational and time management skills, with the ability to prioritize tasks and manage multiple responsibilities Career Growth Opportunities and Learning Benefits At blithequark, we are committed to the growth and development of our employees. As a Healthcare Customer Service Member Advocate, you will have access to a range of training and development opportunities, including: Comprehensive training program, covering all aspects of the role and our systems Ongoing coaching and feedback, to support your growth and development Opportunities for career advancement, within the company and across different departments Professional development opportunities, including conferences, workshops, and online courses A culture of innovation and continuous improvement, with a focus on staying at the forefront of industry trends and best practices Work Environment and Company Culture Highlights At blithequark, we pride ourselves on our positive and supportive work environment. As a Healthcare Customer Service Member Advocate, you will be part of a dynamic and collaborative team, with a focus on: Delivering exceptional customer service and support, with a commitment to quality and excellence Building strong relationships with colleagues, healthcare providers, and members, based on trust, respect, and open communication Fostering a culture of innovation and continuous improvement, with a focus on staying at the forefront of industry trends and best practices Recognizing and rewarding outstanding performance, with a range of incentives and benefits Supporting the well-being and work-life balance of our employees, with a range of benefits and programs Compensation, Perks, and Benefits We offer a competitive compensation package, including: Hiring range: $21.50/Hour, with opportunities for growth and advancement Comprehensive benefits package, including medical, dental, vision, disability coverage options, life insurance coverage, and 401(k) savings plans Paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually Opportunities for professional development and career advancement, with a focus on supporting the growth and development of our employees A dynamic and supportive work environment, with a focus on delivering exceptional customer service and support Conclusion If you are a motivated and compassionate individual, with a passion for delivering exceptional customer service and support, we encourage you to apply for this exciting opportunity. As a Healthcare Customer Service Member Advocate at blithequark, you will be part of a dynamic and collaborative team, dedicated to making a meaningful difference in the lives of our members. With a focus on innovation, integrity, and customer satisfaction, we are committed to providing a positive and supportive work environment, with opportunities for growth and development. Apply today and join our team of dedicated professionals, working together to deliver exceptional results and make a lasting impact in the healthcare industry.