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Member Advocate - Field - New Jersey
About the position
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Must reside in New Jersey Member Advocate Position Summary/Mission Aetna is an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. We collaborate with members, providers, and community organizations in pursuit of quality solutions that address the full continuum of our members' health care and social determinant needs. Dual Eligible Special Needs Plans (DSNP) members are enrolled in Medicare and Medicaid. The Member Advocate is responsible for direct member outreach and engagement Join us in this exciting opportunity as we grow and expand DSNP into new markets across the country.
Responsibilities
- Initiates engagement with assigned members to introduce the program and gather updated member demographic information with speed, accuracy, and a positive attitude
- Schedules completion of the assessment based on the member's preferences and the assigned care manager's schedule.
- Accurately and consistently documents each call in the member's electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements
- Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA
- Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate
- Conducts triage, connecting members with appropriate care team personnel including care managers and customer service when needed
- Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm
- Determined to build strong relationships with peers and our DSNP members
- Demonstrates an outgoing, enthusiastic, and caring presence over the telephone
- Act as a Medicaid recertification specialist for the team
- Must be able to travel 25-40% to attend member meetings.
Requirements
- Experience with computers, including knowledge of Microsoft Word, Outlook, and Excel - data entry and documentation within member records is preferred
- 2 years of experience preferably in customer service, telemarketing, Medicaid, and/or sales
- Call center experience preferred.
- Familiarity with basic medical terminology preferred
- Flexibility with work schedule to meet business needs
- Strong organizational skills, including effective verbal and written communications skills
- Bilingual desired
- The highest level of education desired for candidates in this position is a High School diploma or G.E.D.
Benefits
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
