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
Top Skills
What We Do
We are Oxbridge Health™, an early-stage healthcare company designed to challenge the current paradigm of how people access healthcare, how providers are organized and paid, and how employers engage their employees, to finally break the curve that has been crushing corporations and consumers alike for decades. Comprised of seasoned pioneers in the field of healthcare, whose experience spans multiple organizations and approaches, we have identified a need for a new form of health insurance: one which is built around the power of Episodes of Care. Join us as we work to create the ultimate healthcare logistics company, designed to truly deliver the right care, at the right time, at the right place, for the right price; and as we answer the question: "what if we could present information in a way that consumers could truly be activated--by adding a Fifth Right: the right choice?"
