Member Advocate (Customer Service Rep) – Full Time - UT (Remote/Office)

Job Description: Provides superior customer service to all SelectHealth members and customers via phone, chat, and email. Remote/Work from home opportunities available upon completion of training, phone certification process, and work requirement standards are met. Successful candidates will receive a $1500 sign-on bonus!! $500 paid after successfully completing basic training (60 days) and $1000 paid after successfully completing phone certification and being in the position for 6 months. SelectHealth has been named as one of 12 "Best Companies to Work For" by Utah Business magazine for seven years in a row. Vaccine Requirement – Intermountain is now requiring all new caregivers to receive either two doses of the Pfizer/Moderna vaccine or one dose of the Johnson and Johnson vaccine prior to starting in a new role. Religious and medical exemptions can also be submitted and reviewed in order to waive this requirement. If you are already vaccinated, then consent to sharing vaccination records will be required. Member Advocate – Phones Our training for these positions includes learning how to provide excellent customer service with incoming calls by being a knowledgeable resource, resolving disputes, maintaining confidentiality, and creating an exceptional experience for all. The Member Advocate provides exceptional customer service to all SelectHealth members, employer groups, providers, facilities and other SelectHealth departments. You will help SelectHealth members in finding medical, dental, mental health providers, and give them a superior customer service experience by using multiple programs and methods of resolving their concern. Outstanding benefits. In addition to competitive wages, you’ll also enjoy great benefits, including: In addition to competitive wages, you’ll also enjoy great benefits, including: In-office, remote/work from home, or hybrid (3 in-office/2 home) work environment opportunities after initial in office training, phone certification process, and work requirement standards are met. $1500 sign-on bonus Monthly incentives Referral bonuses Paid time off and holidays Medical, Dental, and Vision insurance 401(k) retirement savings program with an employer match Tuition reimbursement Energetic culture Employee wellness program On-site gym, online wellness classes including fitness, stretching, and mindfulness workshops Monthly wellness webinars Annual employee appreciation week Casual in-office dress code Annual 5k and basketball tournament On-site café and nearby walking paths Job Description As part of Intermountain Healthcare, SelectHealth is more than just an insurance company. We strive to provide our members with low cost insurance options and access to high quality care, while responding to all concerns in a timely manner. Our mission of excellence extends to our employees as well. SelectHealth has been named as one of 12 "Best Companies to Work For" by Utah Business magazine for six years in a row. A Member Advocate assists in directing SelectHealth members to appropriate providers based on the medical and mental health needs of the patient. Providers include physicians, facilities, dentists, and other medical providers. Identifies service options for the member using specific criteria such as urgency, diagnosis, specialty, sub-specialty, provider location, and availability. Gathers information for service approval when provider gaps are identified. Upon hire, a 7-Week Member Advocate training experience is provided for those interested in pursuing a career with SelectHealth. Training includes learning how to provide excellent customer service with incoming calls by being a knowledgeable resource, resolving disputes, maintaining confidentiality, and creating an exceptional experience for all. If selected to advance in the hiring process, this position will include an in office interview. Please review your email closely over the next week for a potential invitation. Entry Rate: $20/hour; plus a potential maximum monthly performance-based bonus of $219 shortly after training in addition to a $1500 sign on bonus paid if in position for 6 months. Benefits Eligible: Yes - Paid time off, tuition reimbursement, medical, dental and vision insurance. Some benefits start immediately, others like medical, dental, and vision start the first of the month following start date Shift Details: Start Date: June 5th, 2023 (In Office Training) Throughout the seven-week training and phone certification process, employees work Monday through Friday, 8:00 a.m. to 4:30 p.m. Due to extensive training, time off will not be approved for the first 60-90 days of employment. Post training, shifts will typically fall within regular business hours: Monday through Friday, 7:00 a.m. to 9:00 p.m., and Saturday 9:00 a.m. to 3:00 p.m. In Office and Remote Options: The opportunity to work from home will be an available option after the completion of training and a phone certification process. Job specific standards and a work at home conducive environment are required before making this transition. This timeline may take a minimum of 6 months after starting in the position. Job Essentials 1. Receives incoming calls from member, providers, facilities, employer groups, and other Select Health affiliates and departments. Triages and researches individual member situations to ensure that they are being referred to the appropriate provider, Instacare, or emergency room. Provides superior customer service that is consistent with policies, company values, quality standards, and service commitments. 2. Works with providers and facilities to prioritize and schedule appointments based on urgency of care required by members. Collects clinical and treatment information from providers in order to guide members to participating providers who can provide the appropriate level of care for their specific condition. Utilizes the PDA (Provider Database Administration) to research provider specialties, and sub-specialties in order to direct care for members requiring specialized treatment. 3. Complies with established standards for call response time, length of call, availability, and call distribution. 4. Complies with established auditing criteria for calls, service approvals, and non-participating reviews. Stays current and conversant on call guidelines to provide accurate information and NCQA compliant service. Works cases within established timelines to ensure that reviews are completed and in compliance with Select Health, NCQA, and CMS guidelines. 5. Maintains the confidentiality of members' personal information to be compliant with internal and external confidentiality policies. Maintains customer history in member tracking using correct codes and detailed comments. 6. Conversant on all Select Health plans, including covered/not covered services, experimental and investigative procedures (M Tech), as well as new plan designs, modifications and documentation updates. 7. Follows established guidelines to conduct nonparticipating provider reviews and allow service approvals for members and providers. 8. Researches and gathers information to prepare cases for nonparticipating review or service approvals, or other referral services. 9. Maintains primary care physician (PCP) assignments for Medicaid and Medicare members and ensure PCP compliance. Assigns PCP's for high utilizers on Medicaid as identified by the UM departments. Minimum Qualifications Demonstrated customer service experience. Demonstrated ability to provide superior customer service. Demonstrated ability to listen and communicate effectively. Demonstrated ability to problem solve and work under pressure. Demonstrated proficiency in navigating computer systems, typing, technologies. Preferred Qualifications Call center experience Remote work or school experience Bilingual in English and Spanish Physical Requirements: SH only Manual dexterity, hearing, seeing, speaking. Location: SelectHealth - Murray Work City: Murray Work State: Utah Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $20.00 - $20.00 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers our commitment to diversity, equity, and inclusion. Intermountain Health is a Utah-based, not-for-profit system of 33 hospitals (includes "virtual" hospital), a Medical Group with more than 3,800 physicians and advanced practice clinicians at about 385 clinics, a health plans division called SelectHealth, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery. Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment. To find out more about us, head to our career site here. Sign up for job alerts! Click ‘sign in’ at the top right corner, create a candidate account, and when we have opportunities that meet your interests, you will receive an email with the job details. Intermountain Health strives to make the application process accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 1-800-843-7820 or email recruitment@imail.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We intentionally work toward an Intermountain Health that reflects our diverse communities and provides culturally competent care, health equity, and a sense of belonging amongst all our caregivers (employees). This is an important part of fulfilling our mission to help people live the healthiest lives possible. The three pillars of our work are talent experience with Intermountain (application, internship, development, etc.), community benefit, and care delivery. Learn more about diversity at Intermountain, here. Introduce yourself to our Talent Acquisition team and we will get in touch if there is a role that seems like a good match. Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100 learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor. All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability or protected veteran status. Women, minorities, individuals with disabilities, and veterans are encouraged to apply. Thanks for your interest in continuing your career with our team!