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About the Role

The Health Services Patient Advocate is responsible for developing, expanding, and maintaining Health Fund programs. This role supports program operations, responds to member and provider issues, and assists members in selecting in-network providers. The Patient Advocate addresses member concerns from inquiry to resolution, engages in marketing, and provides insights for quality enhancement within the Health Services Team.

Responsibilities

Cultivate relationships with management and administrative staff at specified 5 Star Centers to assist in addressing member issues as they arise from the first inquiry to the resolution
Assist members with selecting appropriate providers based on medical criteria and scheduling appointments at 5 Star Centers
Review cases and directly communicate advantages of medical options while also addressing the limitations or alternative options available to members
Investigate member complaints and serve as advocates when a complaint is filed against 5 Star providers to determine a resolution
Investigate and identify any patterns and/or trends of Health Fund program issues with service provision and address accordingly or notify management
Address member concerns about Fund programs
Complete all program enrollment processes for eligible, interested members
Utilize Health Services Database to track interactions related to fund programs
Work with members and the providers to verify the correct copay and research claims to identify all billing errors
Handle and address cases involving out-of-network and non-preferred providers and offer members alternatives for in-network and preferred providers
Confirm if the provider is truly in-network or out-of-network, considering situations where providers may have varying statuses at different sites. Reach out to the provider's offices directly to verify their network status, location information, and participation details
Conduct research on uncommon procedures and verify the provider's capability to deliver services to effectively assist members in making intricate decisions regarding their transition of care
Perform side-by-side shadowing with new employees on all workflows, systems, and case management processes
Perform other tasks and special projects as required by management
Reach out to members and dependents who meet specific criteria for upcoming fund initiatives and our programs
Reach out to members who are unresponsive to third party administrators and vendors to ensure the correct process is followed from initial through completion of care
Handle escalated outreach requests
Receive incoming calls through the Health Services queue regarding Health Fund Programs, billing/claim issues and medical services
Direct escalated claim issues to management and Claims Specialist and relay the outcomes to members
Back up member services provider line queue upon request for provider search activity
Attend and participate in all team meetings
Log member issues into the department tracking system

Requirements

Excellent organizational and prioritizing skills
Work on simultaneous projects with diverse working groups
Ability to clearly communicate ideas and thoughts
Work with minimal supervision and be an effective team player
Effectively work in a fast-paced environment, handle multiple tasks and prioritize work
Excellent listening skills and ability to address member concerns
Work well with physicians and other medical professionals
Think creatively and implement solutions to meet member needs
Navigate multiple systems simultaneously
Read, write and understand English is essential

Skills

Microsoft Office with emphasis on Word and Excel
Strong knowledge base of healthcare industry and medical terminology
Insurance/managed care and claims processing background a plus

Location

Onsite

Work Type

Full-time

Experience Level

Associate’s degree or equivalent work experience in the healthcare industry

Education Level

High School Diploma
Associate’s degree or equivalent work experience in the healthcare industry
Microsoft Office with emphasis on Word and Excel

Salary/Compensations

$1,000/annually for Bilingual

Benefits

Health
Pension
Retirement Savings
Training
Legal Services

About the Company

Building Services 32BJ Benefit Funds (“the Funds”) is the umbrella organization responsible for administering Health, Pension, Retirement Savings, Training, and Legal Services benefits to over 100,000 SEIU 32BJ members.
Our mission is to make significant contributions to the lives of our members by providing high quality benefits and services.
Through our commitment, we embody five core values: Flexibility, Initiative, Respect, Sustainability, and Teamwork (FIRST).
The Funds oversees and manages $9 billion of dollars in assets, which are made up of many, varied and complex funds.
For 2025 and beyond, 32BJ Benefit Funds will continue to drive innovation, equity, and technology insights to further help the lives of our hard-working members and their families.
We use cutting edge technology such as: M365, Dynamics 365 CRM, Dynamics 365 F&O, Azure, AWS, SQL, Snowflake, QlikView, and more.