Company Overview:

Our company is a start-up that specializes in episodes of care benefit plans. We have a deep expertise in episode pricing and analytics and our goal is to bring transparency and efficiency to the healthcare market. Our company is committed to providing high-quality, affordable healthcare to our customers.

Role Description
The Episode Advisor plays a pivotal role in ensuring our members fully understand and

effectively utilize their episode of care benefits. This role requires an understanding of

healthcare benefit plans, insurance terminology, and excellent communication skills.

The ideal candidate will demonstrate empathy, patience, and strong problem-solving

abilities to deliver a positive experience for members during their healthcare journey.

Responsibilities

Member Assistance:

● Provide comprehensive support to members, helping them to understand

and maximize their episode of care benefits.

● Respond to inquiries via phone, email, or chat, offering clear and accurate

information to resolve questions and concerns.

● Initiate outgoing communication to assist members in utilizing their

Episode Advantage benefits

Benefit Plan Explanation:

● Clearly explain details of Episode Advantage benefits, including covered

services, benefit allowance, eligibility, co-payments, deductibles, and any

limitations or exclusions.

Portal Support:

● Guide members in using the member portal, focusing on functionalities

related to Episode Advantage benefits to optimize their overall benefits

usage.

Episode Selection and Care Group Searhc and Confirmation:

● Assist and guide member to search for a episodes of care and

corresponding care groups and guaranteed pricing

● Ensure members understand the value to them of selecting the

appropriate site of care and care group for their need

Claims Support:

● Assist in tracking claims related to episode of care benefits, ensuring

correct association with Episode Advisor Care Team milestones and

resolving claim disputes or denials.

Network Navigation:

● Help members locate in-network healthcare providers and facilities,

providing directories and guidance for selecting appropriate providers.

Benefit Changes and Updates:

● Keep members informed about any changes or updates to their episode of

care benefits.

Complaint Resolution:

● Handle and escalate member complaints, ensuring timely and satisfactory

resolution.

Feedback Collection:

● Collect and communicate member feedback for process improvement.

Collaboration:

● Work cross-functionally with other teams (claims processing, case

management, provider relations) to address complex member issues

Qualifications

● Fluent in Spanish strongly preferred

● Knowledge of healthcare benefit plans and insurance terminology.

● Excellent communication and interpersonal skills.

● Empathetic, patient, and strong problem-solving abilities.

● Demonstrated ability to manage tasks in an orderly and efficient manner and

maintain organized workflows

● Experience in customer service, particularly in a healthcare setting, is preferred.● Proficiency in navigating digital tools and member portals.

● Ability to work collaboratively in a team environment.

● Previous experience in a healthcare-related customer service call center is highly

desirable.

● Self-starter with the ability to thrive in a dynamic, evolving environment