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Role Description

This job provides personalized support and guidance to customers through an omni-channel experience, leveraging knowledge of healthcare administration and integrated partnerships to proactively resolve inquiries, ensuring a positive and seamless experience and ultimately driving positive member behavior and cost-effective business outcomes.

• Serve as the primary point of contact for customers seeking information and assistance regarding their health benefits, claims, and online healthcare tools.
• Resolve standard and frequently non-routine customer inquiries, comments, and concerns with the most limited escalation consistent with company policies and processes.
• Engage and guide members through clinical model complexities; connect members with appropriate clinical and non-clinical resources and redirect member site of care as defined by model and client requirements.
• Educate members on how to optimize insurance benefits by explaining the financial impact of healthcare choices, available provider/service options, and the importance of receiving the right care at the right time and place.
• Enroll members in programs that utilize digital tools designed to enhance their healthcare journey.
• Provide training and support to help members navigate these tools and actively engage in their own health management.
• Other duties as assigned or requested.

Qualifications

• 3 years of experience in customer service, healthcare administration, or related field.
• Experience working with Highmark health plans and customer service systems.
• Associate's degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree (preferred).

Requirements

• Ability to apply in-depth product knowledge of health plan offerings.
• Proficiency in using and navigating customer service systems specific to Highmark health plans.
• Strong communication and interpersonal skills, with a focus on empathy and active listening.
• Ability to work independently and as part of a team.
• Proficiency in Microsoft Office Suite and other relevant software applications.
• Ability to maintain confidentiality and adhere to HIPAA regulations.

Benefits

• Pay Range Minimum: $21.53
• Pay Range Maximum: $32.95
• Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.

Company Description

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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