Human Resources Assistant
Jafferjee Brothers Exports (Pvt) Ltd
Job type full-time
Full job description
Directpath guides employees to make better health care decisions with individualized education for selecting the right benefit plan, expert assistance in making informed care choices and rewards for sensible financial decisions.
Advocates help our members navigate through their employer sponsored benefit programs so that they can make informed healthcare decisions and use their benefits to the fullestOur members are employees of nationwide companies who have employer-sponsored benefit programs.
The medical claims advocate will have a specific focus on resolving medical claims issues and providing education regarding claimsThis position is a work-from-home opportunity.
Advocates begin with a tailored training program, learning what it means to be a directpath advocate, how to use customized applications and systems, and stay current on healthcare industry regulations and changes that may impact service delivery or the member experienceOur advocates are trained and prepared, ready to help members get the most from their benefit programs.
Using our custom designed member-support system, consult with members who require help/guidance/actions with regards to their employer-sponsored benefit program(s)
Document member conversations, follow-ups and resolutions
When necessary, use problem-solving techniques to identify issues, root causes and possible solutions
Set expectations for time-sensitive follow ups, and how the issue will be managed, including possible outcomes
Research and resolve member issues, including consulting with providers, plan administrators, insurance companies
Collaborate with internal colleagues internally to assist and/or transfer, based on need (transparency specialists or nurse advocate)
Create and manage member cases, following strict timing guidelines and methodology; follow through and close cases in a timely manner
Assists with calls and requests that require special handling
Serves as a subject matter expert on advocacy issues for less experienced advocates
Works directly with supervisor to handle escalated and/or high profile issues
Educate members on issues related to using the healthcare system and their specific benefit plan
Maintain acceptable job performance standards
Exhibit a professional and consultative demeanor with members, brokers, employers and customers of all types
Consistently deliver excellent customer service
Maintain a positive attitude in the face of challenging or difficult situations
Experience with salesforce or similar contact management software strongly preferred
Experience with benefits administration platforms is a plus
Ability to read, analyze, and interpret insurance plan documents
Ability to communicate professionally in both written and oral form
Ability to learn and proficiently use internal systems that support the role
Education & background
Bachelor's degree not required, but desired; post high school training or experience in the health insurance field.
Minimum 5 years’ experience in health insurance, employer sponsored benefits, a provider setting, or other similar environment is required
As an industry leader in the employee engagement space, directpath offers our full-time regular employees a comprehensive and competitive compensation and employee benefits packageWith our contribution toward the monthly premium, employees and their families have the choice of a generous group ppo medical plan or a hdhp with a health savings account optionWe also provide company paid long term disability, short term disability, basic life insurance and a critical illness insurance policyAdditional benefits an employee may choose are dental, vision, additional life insurance, accident insurance, additional critical illness insurance, pet insurance and flexible spending accountsRetirement planning is important tooEmployees are eligible to participate in the 401(k) on the first day of employment and eligible for the company match after 6 monthsEmployees also enjoy a flexible time off plan that allows a new hire up to 15 days plus 9 holidays in the first year! (prorated based on date of hire, calendar year)