Handle inbound calls to assist members with health insurance benefits, claims, and eligibility while navigating the healthcare system. Act as a member champion to resolve issues internally across departments and externally with providers and brokers.
Point32Health
7 Remote Job Openings at Point32Health
The Director oversees the success of Medicare Advantage and Supplement product lines, managing P&L, membership growth, and regulatory compliance. They lead the development of multi-year market strategies and coordinate with cross-functional teams to implement product designs and expansion opportunities.
Lead the design and maintenance of the Disaster Recovery framework, plans, and standards to ensure organizational resilience. Coordinate DR testing, track remediation of gaps, and report readiness maturity to leadership.
The Member Service Advocate handles inbound calls to address inquiries regarding health insurance benefits, coverage, and claims while navigating complex healthcare systems. They act as a brand ambassador to ensure member satisfaction, resolve issues, and provide education on self-service tools.
The Behavioral Health Utilization Management Clinician conducts benefit coverage reviews and utilization management according to regulatory guidelines, aiming to ensure clinically appropriate service delivery and support organizational goals. Key duties include adhering to review guidelines, interacting with staff and providers, prioritizing authorization requests, and reviewing various service requests like inpatient admissions and outpatient procedures.
The Senior Training Specialist assists in the needs assessment, design, development, and implementation of training programs, focusing on delivering technical and service skills training for new and experienced staff, particularly in Appeals and Grievances topics. This role also involves creating engaging learning environments, collaborating with SMEs, mentoring peers, leading special projects, and handling complex training issues.
The Member Services Advocate provides exceptional customer service by addressing inquiries and resolving issues related to healthcare. They act as a member champion, collaborating with various departments and external parties to ensure a positive member experience.
