Service Advocate – Ops – Work From Home

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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Position Summary/Mission:

The Health Advocate within the Healthy Outcomes Team interacts with members via multiple channels (digital, telephone) and conducts outreaches to our Medicare members to inspire and encourage healthy behaviors through innovative, compassionate and empathetic communications. The goal of each outreach is to ensure that every member has a clear understanding of the available benefits that are afforded to them under their Medicare plan for specific screenings and medications. The Health Advocate delivers provider and member telephonic outreaches to ensure receipt of important health services, medications and resources to improve Star health outcomes.

The Health Advocate provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives by performing the following:

• Work on one or more of multiple departmental programs that include:
• Inbound and outbound calls to members who would benefit from designated services including healthcare visits/ screenings, vaccination, or medication refill.
• Effective capture of barriers and data collection, use of motivational interviewing skills to provide solutions to facilitate closing gaps in care, and providing best in class support to each member.
• Ensures that every customer is treated professionally, with respect and all questions are thoroughly answered and/or triaged and responded to.
• Acts as an advocate for our Medicare members health needs and helps coordinate care between health plan, doctors and pharmacies.
• Actively listen and collect member reported data elements in the CRM tool to support medical record chasing for HEDIS medical record documentation of services.
• Provides members with the right information at the right time to help them make better decisions about their health and health care, to improve member experience, retention, and growth by efficiently delivering coordination services to members and providers .
• Engages, consults, and educates members based upon the member’s unique needs, preferences and understanding of the services.
• Accepts end to end accountability for the member experience and provides exceptional service.
• Answers questions and resolves issues as a “single-point-of-contact” including escalating to leadership as needed.
• Builds a trusting relationship with the member by taking accountability to fully understand the member’s needs.
• Walk members through programs, Aetna tools and resources to support health care behavior.
• Takes ownership of each member assigned to resolve their issues and connect them with additional services as appropriate.
• Documents and tracks all member contacts, events, and outcomes via appropriate systems and processes.
• Uses professional communication skills to build relationships with both internal and external members/constituents.
• Uses applicable system tools and resources to produce quality business communications including letters and spreadsheets in response to inquiries received.
• Handles multiple functions and/or multiple products while maintaining and/or exceeding performance standards.
• Identifies issues that need to be escalated appropriately and offers suggestions for resolution.
• Demonstrates professionalism and presents a positive image of the company when interacting with members and constituents.
• Supports individual, team and business goals and initiatives; accepts ownership for individual results.

Additional Abilities and Responsibility:

• Windows based application knowledge with ability to use standard corporate software packages and corporate applications with a high degree of computer literacy.
• Effective communication skills and experience speaking with medical providers and/or clinical staff.
• Strong listening and interpersonal skills; skilled at developing and maintaining effective working relationships.
• Strong analytical skills focusing on accuracy and attention to detail.
• Demonstrated ability to de-escalate situations.
• Demonstrated empathy, curiosity, enthusiasm for learning, compassion and listening skills.
• Ability to apply creative thinking skills when needed to solve members’ concerns and have a desire to advocate for them.
• Ability to thrive on change, to adapt to multiple focuses in short amounts of time.
• Ability to work independently, apply critical thinking skills when needed, multitask with ease, and demonstrate professionalism in all interactions.
• Ability to resolve complex issues with sensitivity and discretion.
• Ability to absorb and apply new and changing information.
• Ability to make effective and independent decisions
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment

Required Qualifications:

• Recent and related experience working with HEDIS screening measures and behavior change..
• Prior experience working directly with members / consumers – preferably in a call center setting.
• Minimum 2 years recent and related experience within healthcare, healthcare marketing, outreach and/or health education, health coaching and disease management experience .
• 2 – 4 years of experience in a healthcare setting with direct communication with various levels of management including medical providers.

Preferred Qualification:

• Bilingual or multilingual candidates heavily preferred.
• Bachelor’s degree or equivalent preferred
• Medical certification (certified nursing assistant, medical assistant, etc.) is strongly recommended but not required.

Education and Certification Requirements:

• High School Diploma or G.E.D.