Episode Advisor

Our company is a start-up that specializes in episodes of care benefit plans. We have a deep expertise in episode pricing and analytics and our goal is to bring transparency and efficiency to the healthcare market. Our company is committed to providing high-quality, affordable healthcare to our customers.

● Provide comprehensive support to members, helping them to understand and maximize their episode of care benefits.

● Respond to inquiries via phone, email, or chat, offering clear and accurate information to resolve questions and concerns.

● Initiate outgoing communication to assist members in utilizing their Episode Advantage benefits

● Guide members in using the member portal, focusing on functionalities related to Episode Advantage benefits to optimize their overall benefits usage.

● Assist and guide member to search for a episodes of care and corresponding care groups and guaranteed pricing

● Ensure members understand the value to them of selecting the appropriate site of care and care group for their need

● Assist in tracking claims related to episode of care benefits, ensuring correct association with Episode Advisor Care Team milestones and resolving claim disputes or denials.

● Help members locate in-network healthcare providers and facilities, providing directories and guidance for selecting appropriate providers.

● Handle and escalate member complaints, ensuring timely and satisfactory resolution.

● Collect and communicate member feedback for process improvement.

● Work cross-functionally with other teams (claims processing, case management, provider relations) to address complex member issues

● Fluent in Spanish strongly preferred

● Knowledge of healthcare benefit plans and insurance terminology.

● Excellent communication and interpersonal skills.

● Empathetic, patient, and strong problem-solving abilities.

● Demonstrated ability to manage tasks in an orderly and efficient manner and maintain organized workflows

● Experience in customer service, particularly in a healthcare setting, is preferred.● Proficiency in navigating digital tools and member portals.

● Ability to work collaboratively in a team environment.

● Previous experience in a healthcare-related customer service call center is highly desirable.

● Self-starter with the ability to thrive in a dynamic, evolving environment