Health Services Patient Advocate
New York City, NY
$63K/yr – $65K/yrFull time
Posted 3 days ago
Job Description
Job Code
892
892
Department Name
Health Services
Health Services
Reports To
Health Services Manager
Health Services Manager
FLSA Status
Non Exempt
Non Exempt
Additional Compensation for Bilingual: $1,000/annually
Union Code
53A
53A
Management
No
No
About Us:
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). By following our core values, employees are open to different and new ways of doing things, take active steps to improve the organization, create an environment of trust and respect, approach their work with the intent of a positive outcome, and work collaboratively with colleagues.
The Funds oversees and manages $9 billion of dollars in assets, which are made up of many, varied and complex funds. The dollars come from a number of sources, including the property owners who pay into the funds on behalf of their employees, and as such, requires those who oversee and manage the money to be highly skilled financial management people.
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.
Please take a moment to watch our video to learn more about our culture and contributions to our members: youtu.be/hYNdMGLn19A
Job Summary:
This position is a key part of developing, expanding, and maintaining the Health Fund programs. The Health Services Patient Advocate is responsible for the maintenance of relationships with the 5 Star Centers, supporting the operations of the Health Fund Programs, responding to member and provider issues, and assisting members in choosing in-network providers, particularly 5 Star Centers and partnered providers. The Patient Advocate for Health Services addresses member concerns from the initial inquiry stage through resolution, engages in marketing strategies, and offers insights for ongoing quality enhancement of the Health Services Team. Furthermore, this role also contributes to various operational support tasks within the Health Services Team.
Essential Duties and 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
Qualifications (Competencies):
- 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
Education:
- High School Diploma
- Associate’s degree or equivalent work experience in the healthcare industry
- 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
Language Skills:
- Bilingual in English/Spanish is preferred
Shift
9:00 AM to 5:00 PM
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.
- Under 1/3 of the time: Standing, Walking, Climbing or Balancing, Stooping, Kneeling, Crouching, or Crawling
- Over 2/3 of the time: Talking or Hearing
- 100% of the time: Using Hands
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
- 1/3 to 2/3 of the time: Work near moving or mechanical parts, exposure to radiation, moderate noise.
Building Service 32BJ Benefit Funds
The Building Service 32BJ Benefit Funds is the umbrella organization responsible for administering benefits, including Health, Pension, Retirement Savings, Training and Legal Services benefits to over 100,000 SEIU 32BJ members. SEIU 32BJ is the union representing property service workers, including office cleaners and residential doormen and superintendants, from Connecticut through Florida.PensionThe Pension Fund provides retirement security for members and their spouses through a regular monthly pension benefit based on their years of service.Retirement ServicesThe Supplement Retirement Savings Plan (SRSP) strengthens members’ retirement security through self directed retirement accounts funded by both employer contributions and participant savings.HealthThe Health Fund provides comprehensive, affordable high quality health benefits to members and their families.TrainingThe Training Fund offers more than 100 different courses and seminars, ranging from Green Buildings to English as a Second Language, and everything in-between.LegalThe Legal Fund provides legal representation to members, retirees and their dependants in a broad range of matters, including family, immigration, consumer and criminal law.The Benefit Funds’ main office is in New York City, with satellite offices in New Jersey, Connecticut and Washington, DC.
Founded in 2015
New York, New York, USA
405 employees (7 in marketing)
Salaries
Posted range
$63K/yr – $65K/yr
Taken straight from the job posting.
