JOB DESCRIPTION
TITLE:MEDICAL PATIENT ADVOCATE
FLSA:NON-EXEMPT
REPORTS TO:TBD
DATE:JANUARY 1, 2021
The Medical Patient Advocate will provide resources and guidance to members, enabling them to apply for and receive services
related to their medical benefit. Interview members to determine benefits and assistance eligibility. Interact with pharmacies,
third party administrators, claims adjustors, medical professionals, and financial assistance programs to determine services.
Respond to telephone calls. Maintain files, process incoming email, and provide other general support to members.
Responsible to maintain quality enrollment services relationships with their assigned individuals. Requires strong communication
skills both written and verbal with the ability to represent and support member and client needs.
ESSENTIAL FUNCTIONS:
• Communicates professionally and effectively - both verbal and written.
• Provide resources and materials to members, enabling them to apply for and receive services
• Maintain member records in salesforce or other approved documentation program
• Escalates to leadership any unresolved member enrollment issues
• Resolves problems/issues independently.
• Deliver data results to clients, brokers, and internal partners
• Complete on-site and phone enrollments for assigned members
• Work internally with multiple departments to promote timely and accurate resolution of member
inquiries.
Maintains strong working relationship with external partners.
MINIMUM QUALIFICATIONS:
• Associate’s or technical degree in a healthcare related field or three years relevant work experience
• Experience using Excel for data analysis and reporting.
• Extensive knowledge of the Microsoft Office Systems to include, Word, Excel, and Outlook
• Ability to travel up to 10% of the time to meet with brokers and clients
• Strong organizational skills with the ability to multi-task
• Ability to work in a virtual team environment
Extensive knowledge of TPA operations
5 years of medical claims processing experience
PREFERRED SKILLS:
• Strong customer service background and experience.
Strong medical claims processing background and experience.
Working knowledge of medical benefit systems
Ability to interpret medical benefit plan summaries.
• Proven ability to complete and manage quick turnaround, tactical projects.
• Working knowledge of pharmacy benefit claim systems.
• Possess ability to handle responsibility, is self-directed with strong organizational and documentation
skills.
• Possess ability to work independently and efficiently under deadlines to meet commitments.
• Possess a high degree of creative ability, analytical and technical skills with independent judgment.
• Pharmacy Technician or strong pharmacy background
Medical claims adjustor or strong medical background
• Ability to work as a team member effectively interacting with clients, team members and across
departments.
• Implements and maintains assigned member enrollment.