Careers

Our Personal Health Advocates (PHA) are compassionate and dedicated professionals who understand the intricacies of the healthcare system and how to navigate through it. When a member contacts Health Advocate, she or he establishes a relationship with one of our PHAs who stays with the member through to the resolution of their problem. Our PHAs demonstrate a commitment to service excellence, have strong problem solving skills and support members as they seek healthcare services and interact with providers and insurers. Personal Health Advocates work in tandem with Medical Directors and with our team of administrative experts who handle claims, benefits, grievances and paperwork issues.

Job Description - As a Personal Health Advocate, you will:

• Coordinate healthcare related services
• Assist members with coverage and benefits issues
• Negotiate fees with healthcare providers
• Identify and locate physicians, hospitals, wellness services, senior care and behavioral health services
• Represent members during appeals processes as appropriate
• Provide claims assistance by investigating and solving complex claims

Qualifications

• Licensed RN
• Minimum of 3-5 years working in healthcare with a background in case management or utilization management preferred
• Excellent problem-solving skills
• Excellent verbal and written communication skills
• Good time management, organization, research, analytical, negotiation and interpersonal skills
• Proficiency with various software applications (Excel, Word) and familiarity with the web/Internet
• Able to work independently with a minimum of supervision
• High work ethic, results-oriented, and a good, compassionate listener
• Able to work flexible weekdays, including some evenings until 9 PM
• Bilingual in Spanish/English a plus

Coordinate and supervise the pre-service clinical and research activities of a team of Personal Health Advocates (RNs) and Customer Care Associates.  Perform administrative responsibilities and oversight to support services that assist members in navigating the healthcare system.

Work involves managing complex case files by utilizing employer/carrier information, health resources (as directed by Health Advocate™), medical directors, and subject matter experts within Health Advocate.

Regular contact with employees, members, physician offices, hospital staff, nursing networks, insurance carriers, community organizations, and federal, state, and county employees.

Job Description – As a Clinical Supervisor, you will

• Ensure that the Call Center Metrics are met or exceeded (ASA = <30 seconds; Abandon Rate = <5%)
• Coordinate and supervise the pre-service clinical and research advocacy for a team of PHAs, CCAs, and Behavioral Health Specialists
• Provide organization, direction and staffing for intake calls and phone queue assignments to ensure all calls are answered in accordance with Health Advocate’s policies and procedures
• Monitor calls and audit case files daily to ensure the proper target resolution is identified and that, if possible, the case is closed at or near the target resolution
• Provide strong leadership and promote effective teamwork
• Ensure assigned staff meets or exceeds the standards, results, and responsibilities of their respective positions
• Coach, mentor, and evaluate the performance of an assigned team
• Assist in the selection, counseling, and discipline of all program staff on the team
• Provide oversight and direction to staff for assigned cases
• Responsible for problem-solving issues and coordinating efforts with internal departments and subject matter experts
• Take responsibility for a complex case management portfolio
• Provide clinical consultation and support when appropriate to all internal departments
• Conduct follow-up calls with select members to measure levels of member satisfaction
• Routinely evaluate and monitor call center needs and case management procedures to recommend any necessary changes to the Director of Operations
• Escalate cases through the appropriate channels in accordance with Health Advocates policies and procedures
• Routinely evaluate and monitor service calls and case management procedures to recommend any necessary changes to the Director or Operations
• Escalate cases through the appropriate channels in accordance with Health Advocate’s policies and procedures
• Document all cases in case management system using the SOAP method (Subjection, Objective, Assessment and Plan) when appropriate
  

Qualifications          

• Prior relevant management or supervisory experience
• Active and unrestricted State or Multi-State RN license
• Minimum five years clinical and/or medical management experience
• Strong leadership skills and the ability to build effective teams
• Certified Professional in Healthcare Quality helpful
• Certified Rehabilitation Registered Nurse helpful
• Telephone triage experience helpful
• Case Management experience
• Understanding of health benefit plans and the insurance industry
• Understanding of physician office procedures, including billing, diagnosis codes, and pre-certification process
• Understanding of Home Care Services
• Strong desire to provide outstanding customer service
• Ability to work as part of a team
• Ability to educate callers
• Strong listening skills and empathy 
• Ability to ask open-ended questions and uncover information
• Effective communication skills to interact with members, physicians, and insurance carrier representatives
• Special ability in mediating or negotiating compromises without alienating any party
• Ability to calm anxious callers and defusing angry or hostile callers
• Assertive, self-confident, and resilient
• Attention to detail and strong documentation skills
• Proficient computer skills (Microsoft Office, Excel, Outlook, Adobe PDF, Internet Searches)

Job Summary:
Contact clients in person and via phone to develop a relationship, sell additional services, and create a communication plan.  Implement and evaluate the communication plan developed.

Duties and Responsibilities:

• Conduct appointments with clients
• Make outbound visits/calls to clients
• Sell additional services to clients
• Develop a systematic effective communication plan for employees
• Send follow up correspondence
• Contact and follow through on all matters relating to the client relationship with Health Advocate
• Work with clients to increase employees use of Health Advocate
• Work with Sales Vice President in developing strategy for client

Knowledge, Skills, and Abilities:

• Sales skills
• Excellent communication skills
• Professional telephone sales skills
• Professional appearance
• PC skills with a proficiency in Microsoft Office
• Ability to establish priorities, work independently and proceed with objectives without supervision

Credentials and Experience:

• BA/BS College degree
• Sales experience
• Experience in benefits a plus

Special Requirements:
Ability to travel unconditionally (50%)

Our Appeals Specialists are compassionate, dedicated individuals with exceptional problem-solving skills.  They handle complex issues with minimal supervision.  They assist members with health insurance appeals.  They analyze and research denied medical claims and lead efforts to resolve claims issues on behalf of the member.  They process appeals within federally mandated timeframes.  They escalate claims with managerial levels of insurance carriers or group administrators.

Job Description- As an Appeals Specialist, you will:

• Review denial letters, Explanation of Benefits and communications
• Provide guidance and advice to members pursuing health insurance appeals
• Identify contractual appeal timeframes
• Review plan benefit documents such as Summary Plan Descriptions, Certificates of Coverage
• Research validity of denial reasons identified by insurer
• Obtain and review any relevant records and documentation from plan administrator and provider of service
• Ensure documentation is clear and concise for appropriate outcome
• Compassionately communicate with members and provide benefit education to members as needed
• Adhere to all laws and company policy regarding confidentiality of privileged patient information and appeals administration
• Guide, assist or write letters in relation to member appeals
• Assist members preparing for oral appeals hearings

Qualifications

• Bachelor’s Degree
• Compassionate and caring nature with a strong desire to advocate for others
• 3+ years working in health insurance appeals, HR health benefits, health benefits brokerage or other health benefits related environment
• Knowledge of authorization, medical policy and claims payment guidelines in an effort to determine if appeal requires a clinical review or an administrative review.
• Personal computer experience required including a working knowledge of Microsoft Office, Word, Excel, and web based computer applications
• Strong communication and interpersonal skills
• Ability to multi-task in a high volume environment at a fast pace
• Strong analytical, math, communication, verbal and writing skills
• Bilingual in Spanish/English a plus

At Health Advocate, we are committed to providing our customers with services that improve the health, well-being and productivity of their employees.  We are looking for the right people with experience who can respond to benefits inquiries and assist members with plan selection decisions. Our Benefit Specialists telephonically provide high quality support to the employees of our clients. Members receive help in understanding their benefit plan offering, and direction in working through a variety of benefit issues. The Benefit Specialist will be required to interface with many internal and external resources to provide guidance and direction regarding plan options, cost factors and detailed benefit review.

Job Responsibilities:

• Professionally answers incoming calls and respond to member inquiries.
• Provide guidance to members on open enrollment issues, questions and concerns about benefit options.
• Connect with customers by phone and quickly develop a rapport to help the individual to navigate their benefit choices and options
• Educate customers on health benefits options and programs offered by their employer
• Answer customer questions related to Benefit Plans (i.e. medical, dental, life, STD, LTD), consumer-driven health plans, FSAs, provider selection, qualifying life events and the open enrollment process
• Place outbound follow up calls for issues that can not be resolved during the initial call

Preferred Qualifications:

• Bachelor's Degree or other applicable work experience.
• 3 years prior benefits experience preferred
• Strong communication skills and phone etiquette
• Strong ability to explain complex issues to employees/retirees
• Highly effectively listening skills
• Strong problem solving/issue resolution skills
• Excellent customer service and customer resolution skills
• Experience with Microsoft Word and Excel
• Ability to work in a team environment.

Certificates/licenses:

• CEBS, PHR, SPHR or CBP certification a plus.
• Completed health/life licensing coursework and/or attainment of license and completion of continuing education coursework a plus.

Our Claims Specialists are compassionate, dedicated individuals with first-rate listening and problem-solving skills who enjoy the challenge of resolving complex billing and claims issues. When a member contacts Health Advocate about a claims issue, the member establishes a relationship with one of our claims specialists who works with the member through to the resolution of their problem.

Job Description- As a Claims Specialist, you will:

• Research and solve claims and billing issues
• Interface with insurance carriers, physicians, hospitals and other healthcare providers
• Help members with eligibility and benefits coverage questions
• Assist in negotiating fees with healthcare providers on behalf of members

Qualifications

• Must have 3 years medical and/or dental billing/claims experience
• Must have experience working with health plan documents, benefit plans
• Must have excellent customer service skills
• Experience with fee negotiation desirable
• Ability to follow-up with health plans, providers and members to resolve questions and problems
• Knowledge of CPT, ICD-9 and HCPCS coding
• Top-notch verbal and written communication skills
• Proficiency with various software applications (Outlook, Excel, Word) and computer systems
• Familiarity with the web/Internet
• Ability to work flexible weekdays, including some evenings until 9 PM
• Bilingual in Spanish/English a plus

A Claims Unit Supervisor is needed to manage an operational unit that allows us to best serve our clients and employees in providing answers regarding employee benefit plans. Responsibilities include managing workflow within a phone and research unit, developing and implementing policies and procedures and training staff to perform specific functions and managing employee performance.

The right candidate will lead recruiting, hiring and training efforts that enable creative solutions to identifying the best candidates and enabling the new hires for success.

Job Description. As a Claims Unit Supervisor, you will:

• Hold responsibility for the administrative functions and supervision of a claims service unit. This includes backlog and quality management for a team of Claims Specialists
• Provide organization, direction and staffing for all assigned service calls and case load assignments to ensure all calls are answered in accordance with Health Advocate’s policies and procedures
• Monitor calls and audit case files daily to ensure the proper target resolution is identified and that, if possible, the case is closed at or near the target resolution
• Ensure assigned staff members meet or exceed the standards, results, and responsibilities of their respective positions
• Coach, mentor, and evaluate the performance of an assigned team
• Assist in the selection, counseling, and discipline of all staff on the team.
• Provide oversight and direction to staff for assigned cases
• Hold responsibility for problem-solving issues and coordinating efforts with internal departments and subject matter experts
• Provide benefit and claims consultation and support when appropriate to all internal departments
• Routinely evaluate and monitor service calls and case management procedures to recommend any necessary changes to the Operations Manager
• Escalate cases through the appropriate channels in accordance with Health Advocate’s policies and procedures

Qualifications

• Claims or Call center experience preferred
• Bachelor's Degree or applicable work experience
• Management or supervisory experience in benefits or claims processing
• Strong leadership skills and the ability to build effective teams
• Effective communication skills to interact with members, physicians, and insurance carrier representatives, with an emphasis on ability to communicate both verbally and in writing
• Assertive, self-confident, and resilient.
• Basic computer skills
• Ability to search and identify resources through the internet.
• Demonstrated ability to communicate concepts, strategies and plans in terminology understood by business professionals.
• Ability to interpret Explanation of Benefits (EOBs).
• Familiarity with various types of health insurance coverage, coordination of benefits, and UCR fees

Our Customer Care Associates are compassionate and dedicated professionals with exceptional listening skills who assist our members in navigating the healthcare system. They work as part of a team and demonstrate customer service excellence.

Job Description- As a Customer Care Associate, you will:

• Assist in locating primary care physicians and dentists
• Thoroughly explain benefit plans to members
• Work as a team member to assist nurses in researching providers, eldercare, nursing homes
• Identify resources and options to assist members
• Concisely and accurately enter documentation into system
• Initial intake/triage of incoming calls- responsible for inputting demographic information into the system and getting the member to the right person

Qualifications

• Excellent verbal and written communication skills required for speaking to members, physicians’ offices, hospitals, insurance companies, healthcare facilities and for noting this in computer system for follow-up
• Attention to detail required for tracking cases and following-up with members and providers on a timely basis
• Must be organized and have ability to multi-task and handle multiple cases
• Team player – willing to learn, assist and help other team members as required
• Must have excellent customer service skills
• A minimum of one year experience in healthcare
• Bilingual in Spanish/English a plus

At Health Advocate, we are committed to providing our customers with services that improve the health, well-being and productivity of their employees. We are looking for the right people with experience who can respond to benefits inquiries and assist members with plan selection decisions. The Benefits Specialist will be required to interface with many internal and external resources to provide guidance and direction regarding plan options, cost factors and detailed benefit review.

At Health Advocate, we are committed to providing our customers with expertise and services that improve the health, well-being and productivity of their employees. We are looking for the right person to: implement client requirements from set up, eligibility, reporting, training and QA perspectives.

The appropriate candidate would be responsible for overseeing all aspects of a client interface: developing requirements, ensuring data transfer needs are met, design and deliver training to support customer specifics and Quality adherence. Developing and implementing new hire and professional staff training.

The right candidate will have direct client experience, design creative solutions to meet unique client. The best candidate will have worked on training and quality initiatives for a thriving organization. The development aspect of the role includes implementing system, process and workflow solutions to meet customer needs.

An important factor in this role will be a productive working relationship with internal personnel both operations and sales for continuous improvement plans.

Job Responsibilities:

• Manage the Client Service team whose functions include:
  • Loading Inbound eligibility data
  • Exporting files for key clients
  • Installing new cases
  • Extract for billing
• Account Management
• Manage the training staff, which includes training design and delivery to both new hires and existing personnel
• Develop and Implement Quality Assurance Process and develop client specific reports re: Quality
• Act as the liaison between the operational units to ensure that continuous improvement is being developed for the service personnel to meet the clients and members needs
• Participate in Site Visits with Clients to explain core functions, demo system and detail operational plans
• Competent to work at an independent level with clients and internal personnel

Qualifications:

• Bachelor's Degree or applicable work experience
• Direct contact with corporate clients in a service or project management capacity
• Proven skills on systems and projects/enhancements with at least 3 years of solid, diverse work experience desired
• A technical skill-set including prior systems testing or business systems design experience
• Demonstrated ability to communicate concepts, strategies and plans in terminology understood by business professionals
• Excellent interpersonal skills - with an emphasis on ability to communicate both verbally and in writing
• Ability to work in a team based environment required
• Ability to work directly with business partners, clients and vendors required

A Key Account Specialist is needed with proven systems skills and technical experience in prior systems testing or business systems design to install new customers. Responsibilities include interfacing with the sales and operations personnel to obtain appropriate content and to work with the systems personnel on customer programming and/or reporting needs. Successful candidates must have a demonstrated ability to communicate technical concepts strategies and planning terminology understood by business and IT professionals and direct contact experience with corporate clients in a service or project management capacity.
This position reports to the Director of Client Services.

Job Description: As a Key Account Specialist, you will:

1. Serve as the primary contact for the sales team and customers to install clients in a timely manner
2. Produce and distribute installation calendar to ensure timely delivery of installation services
3. Serve as a contact for new clients with questions about installation needs. This includes passwords and access to secure FTP site, file format requirements and loading of eligibility data
4. Accountable for the timely and high quality production of the customer requirements. Performs critical information gathering and interpretation to ensure client specifications regarding products, structure, billing, and eligibility
5. Accountable for tracking the resolution of client issues, following up with other Health Advocate areas to ensure timely resolution
6. Provide support to assigned accounts by responding to inquiries or resolving issues of concern
7. Serve as liaison between the operational units and the sales team to ensure a smooth and complete installation of a client’s account
8. Obtain client specific contractual information and develop it as an accessible reference for operational staff. This includes evaluating current system capabilities and determining best method of data/content storage
9. Enter client data into various core system applications to ensure data integrity and availability to operations staff
10. Documents, tests, implements and provides on-going support for the client’s data and supporting applications
11. Serve as the technical support contact for the reporting database and other systems used by the business enterprise

Qualifications

• Bachelor’s Degree or applicable work experience; incumbents typically have more than 3 years of related experience
• Proven skills on systems and projects/enhancements with at least 3 years of solid, diverse work experience desired
• Ability to perform tasks independent of direct supervision with good follow up
• Excellent organizational skills and time management skills
• Knowledge of insurance products is preferred
• Direct contact with corporate clients in a service or project management capacity
• A technical skill-set including prior systems testing or business systems design experience. Working knowledge of database structures
• Demonstrated ability to communicate technical concepts, strategies and plans in terminology understood by business and IT professionals
• Excellent interpersonal skills - with an emphasis on ability to communicate both verbally and in writing
• Ability to work in a team-based environment required
• Ability to work directly with business partners, clients and vendors required

Health Advocate is seeking proven sales representatives in cities across the nation.  Responsibilities include new business sales to employers, unions, TPAs, brokers/consultants and other plan sponsors, regionally and nationally.
                             
Successful candidates must be self-starters with excellent communication skills and have a proven track record.  Three to five years successful sales experience working with employee benefits and human resources departments and relationships with decision makers are a plus.  College degree required.  Compensation includes competitive salary, commission and excellent benefits.

If you are submitting your resume via email, kindly type "Sales" in the subject line.  If you are sending your resume via mail, please include "Attn:  Sales" on the envelope.

At Health Advocate, we are committed to providing our clients with services and products that improve the health, well-being and productivity of their employees. 

We are seeking sales professionals in Chicago, Texas, Northern California, Southern California and Midwest.  Responsibilities include new business sales to employers, unions, TPAs, brokers/consultants and other plan sponsors, regionally and nationally.

Successful candidates must be self-starters with excellent communication skills and have a proven track record. 

This is not an entry level position.  Previous sales experience in selling healthcare services and products in a Business to Business environment selling to Benefits and HR professionals is required.

Three to five years successful sales experience working with employee benefits and human resource departments and relationships with decision makers is a plus.

• Use sales plan and initiatives to maintain and increase client/referral base
• Develop relationships with referral in brokers, consultants, direct sales and lead generators to meet targeted financial and subscriber quotas.
• Develop and execute sales plan that is consistent with sales analysis.
• Responsible for achieving subscriber quota and revenue quotas through use of  both existing and new referral sources
• Accomplish a set number of sales calls, cold calls, mailers and other activities to achieve sale success.

Qualifications

• Bachelor’s Degree or other applicable work experience
• Excellent verbal and written communication skills
• Strong facilitation, presentation and negotiation skills
• Previous success with cold calling in a new business development environment
• Ability to meet aggressive revenue and profitability targets
• Good time management, organization, sales and interpersonal skills
• Able to work independently with a minimum of supervision
• High work ethic and results oriented
• Minimum of 3 years relevant sales experience in health care products
• Track record for generating new business and interacting with leadership teams
• Dedication to teamwork
• Willingness to travel
• An uncompromising commitment to quality and a passion for health care advocacy

Please send your resume to drocchino@healthadvocate.com. 
Please no phone calls!

At Health Advocate, we are committed to providing our clients with services and products that improve the health, well-being and productivity of their employees. 

We are seeking a Sales Product Specialist to introduce and support in an aggressive sales environment a new and exciting product/ service involving working with employers to contract and implement Health Advocate’s new Benefits Gateway Dashboard.  This person is responsible for participating in the sale and installation of a tool that connects, collects and stratifies data feeds from the various vendors the employer works with for a fully integrated and coordinated approach managing the over all health and welfare of their employees.

• Assist in selling and supporting a sales team on the product
• Work with the employer on the implementation and the ongoing management of the data feeds and reporting for the dashboards.
•  Work with Product Development to provide information and feedback to improve upon the product and process.

Qualifications

• Bachelor’s Degree or other applicable work experience
• Background in database platforms
• Working knowledge of data mining protocols, especially in the clinical field.
• Experience creating data acquisition to enable enterprise intelligence
• Technical knowledge of platform operating systems
• Excellent presentation skills
• Excellent verbal and written communications
• Good time management, organization, sales and interpersonal skills
• Able to work independently with a minimum of supervision
• High work ethic and results oriented
• Dedication to teamwork
• Willingness to travel
• An uncompromising commitment to quality and a passion for health care advocacy

Please send your resume to drocchino@healthadvocate.com. 
Please no phone calls!

At Health Advocate, we are committed to providing our clients with services and products that improve the health, well-being and productivity of their employees. 

We are looking for a Sales Field Trainer to train and support the sales professionals in the field on all existing and new products and services

• Design, develop and implement training programs/workshops for sales professionals
• Partner with Chief Sales Officer to improve employee performance and business results
• Work with Subject Matter Experts (SMEs) to deliver training
• Ensure learning plans meet functional needs to support larger enterprise wide strategies
• Design and develop learning material using instructional design and a variety of media
• Prepare written materials appropriate to the audience and course goal
• Ride with field sales force for pre-call planning, assistance in the call and post call analysis
• Report to Chief Sales Officer areas of need for improvement on an individual and global basis

Qualifications

• Bachelor’s Degree or other applicable work experience
• Experience with learning theory
• Project management skills
• Strong customer service skills
• Proven analytical and problem-solving skills
• Facilitation skills
• Excellent interpersonal skills with emphasis on ability to effectively communicate both verbally and in writing
• Demonstrated ability to communicate various concepts, strategies and workflows in terminology understood by business professionals
• Good time management, organization, sales and interpersonal skills
• Able to work independently with a minimum of supervision
• High work ethic and results oriented
• Dedication to teamwork
• Willingness to travel nationwide 30-40% of the time
• An uncompromising commitment to quality and a passion for health care advocacy

Please send your resume to drocchino@healthadvocate.com. 
Please no phone calls!

At Health Advocate, we are committed to providing our customers with expertise and services that improve the health, well-being and productivity of their employees.  We are looking for the right person to: Manage the operational unit that handles the provider locator process. 

The appropriate candidate would be responsible for meeting service metrics by managing workflow, developing and implementing policies and procedures, training staff to perform specific functions and managing employee performance..

The right candidate will lead recruiting, hiring and training efforts that enable creative solutions to identifying the best candidates and enabling the new hires for success.

Job Responsibilities

• Responsible for the administrative functions and supervision of a research unit. This includes backlog and quality management for a team of Research Associates.
• Provide organization, direction and staffing for all assigned locators to ensure that all work is completed in accordance with Health Advocate’s policies and procedures.
• Monitor calls and audit case files daily to ensure the proper procedures are adhered to and that, if possible, the case is closed at or near the target resolution date.
• Ensure assigned staff members meet or exceed the standards, results, and responsibilities of their respective positions.
• Coach, mentor, and evaluate the performance of an assigned team.
• Assist in the selection, counseling, and discipline of all staff on the team.
• Provide oversight and direction to staff for assigned cases.
• Responsible for problem-solving issues and coordinating efforts with internal departments and subject matter experts.
• Provide research consultation and support when appropriate to all internal departments.
• Routinely evaluate and monitor outbound calls and case management procedures to recommend any necessary changes to the Operations Manager.
• Escalate cases through the appropriate channels in accordance with Health Advocate’s policies and    procedures.

Qualifications

• Call center experience preferred.
• Bachelor's Degree or applicable work experience.
• Management or supervisory experience.
• Strong leadership skills and the ability to build effective teams.
• Effective communication skills to interact with members, physicians, and insurance carrier representatives, with an emphasis on ability to communicate both verbally and in writing.
• Assertive, self-confident, and resilient.
• Proficient in Microsoft applications (Word, Excel, Outlook)
• Ability to search and identify resources through the internet.
• Demonstrated ability to communicate concepts, strategies and plans in terminology understood by business professionals.
• Familiarity with various types of health insurance coverage.