Client Member Specialist

Job ID: J119854
Company: Highmark Inc
Location: Home, PA, United States
Facility: Work From Home
Full/Part Time: Full time
Job Type: Regular
Posted at:

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Description

This job collaborates with Sales Client Management and the Sales Executive team. The position will develop member transition strategies to steer the transition of members to AHN and community providers; thereby minimizing future member disruption.  This position is responsible for educating members about how their insurance benefits work, the financial impact of healthcare choices, available provider/service options and the importance of getting the right care at the right time, in the right place.  The incumbent will play a major role in driving change in member behavior and driving overall business outcomes from a cost of care perspective.   

**We are hiring 2 Client Member Specialists who will need to sit in close vicinity to Pittsburgh, PA and support the surrounding Pittsburgh location territory. The role is a work at home position with travel to this territory >50% of the time.

ESSENTIAL RESPONSIBILITIES:

  • Empower members to make informed decisions by evaluating the most appropriate type of provider for members' unique needs, assess which providers are in-network and ensure that the members are fully informed of the tools and resources available to transition to AHN or other community providers.
  • Advocate for the member by providing assistance with transferring medical records, making prompt appointments with AHN or other community providers and providing assistance with resolving claim or billing issues.  Educate members about access to comprehensive  clinical care and demonstrate the quality of care and advanced outcomes of partner network providers.  Assist members in engaging medical care from higher quality, more cost effective providers closer to their homes.  Create new and innovative opportunities for members to interact with patient-focused providers and experience the quality of care first hand for various specialties.  Showcase the latest developments in quality of care and the results of investments from AHN and community partner providers.
  • Demonstrate business acumen by partnering with, and developing proactive sales strategies with the Organization's Sales team and executing these strategies by influencing member buying decisions at enrollment events focused on not only maintaining enrollment but increasing the Organization's enrollment and profitability.   
  • Participate in the development of sales strategies with the Organization's Sales Team, as well as executing those strategies in sales situations by influencing member buying decisions to purchase supplemental Lines of coverage for growth and/or retention of contracts and increase profitability for HMIG products along with the dental and vision companies on a regional and national basis.  Activities include, but are not limited to, scheduling and facilitating meetings with employers, members and AHN and community provider partners.
  • Identify and research operational issues based on member/client feedback and transition details to the appropriate internal department (including but not limited to Product Management, membership, claims, eMarketing, etc.). Identify any opportunities for process improvements.  Success will be dependent on partnering with the appropriate subject matter experts in diverse areas of the enterprise 
  • Drive changes in member behaviors by developing strategies that influence change and create action from benefit executives and individual members, including development of incentive models, creating connections and relationships between executives at the Organization, employer organizations and demonstrating the financial impacts of decisions for employers and members.
  • Other duties as assigned or requested.

REQUIRED EDUCATION:

  • Bachelor's Degree - Business, Communications or related OR 6 years applicable experience in lieu of Bachelor degree

EXPERIENCE:

  • 3 - 5 years of prior sales or client consulting experience preferably in the insurance industry

SKILLS:

  • Strong relationship builder across multiple levels of an organization from employee through senior leader
  • Strong communication and influence skills across levels of an organization from employee through senior leaders
  • Able to work effectively in a matrix environment
  • Able to juggle and manage competing priorities
  • Strong presentation and written communication skills
  • Strong analytical skills /financial acumen

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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