Are you an experienced customer service professional looking for a rewarding opportunity in the healthcare field? Crossroads Healthcare Management is hiring a full-time Member Advocate to join our dedicated team.
About Us: Crossroads Healthcare Management is a trusted third-party administrator (TPA) managing multi-employer, self-funded health plans for our clients. We collaborate with major PPO networks in the New York area, all in accordance with the terms of the various plan’s Summary Plan Descriptions (SPD’s). These multi-tiered plans provide hospital, major medical, prescription drug, dental, vision, short-term disability, life insurance and AD&D benefits to approximately 15,000 active union members and their eligible dependents, including retirees and beneficiaries. Our client's members primarily work in the greater New York area.
Position Overview: As a Member Advocate you will handle inbound and outbound calls, assisting members and providers with care coordination needs. This role requires strong communication skills, knowledge of health plan benefits, and familiarity with medical coding, terminology, and managed care programs. Bilingual skills are a valuable plus.
Key Responsibilities:
- Handle inbound calls regarding claims, eligibility, and other inquiries.
- Coordinate care between patients and external referral entities.
- Process precertification and prior authorization requests.
- Assist management in reviewing, researching and summarizing participant appeals for the Board of Trustees.
- Contribute to special projects and reporting assignments as needed.
Requirements:
- Minimum of three (3) years of customer service experience, preferably in healthcare.
- High school diploma required; Bachelor's degree preferred.
- Proficiency in medical terminology, coding (HCPCS, ICD-10, CPT, etc.), and employee health plan(s) benefits interpretation.
- Strong organizational, problem-solving, analytical, and communication skills.
- Ability to work collaboratively as part of a team.
Work Experience: Minimum of three years working experience in medical customer service and call center setting.
Educational Background: High school diploma required.
If you're passionate about providing exceptional member support and making a difference in healthcare, we want to hear from you! Apply today to embark on a fulfilling career journey with Crossroads Healthcare Management.
Job Type: Full-time
Pay: $22.00 - $24.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
- Work from home
Work Location: In person
