Job Description
Specialist Management Solutions is a division of SCA Health which is part of Optum. Specialist Management Solutions (SMS) provides a benefit solution that helps large, self-insured employers and health plans manage and drive down outpatient surgical spend, empowering employees/members with knowledge and education regarding the cost benefits of high-quality ambulatory surgery centers (ASCs) and Centers of Excellence (COEs). Through an optimized member experience with a concierge navigation approach, SMS focuses to guide members on appropriate care decisions (surgical or non-surgical) and sets them on a path for the right treatment and improved health outcomes. Ultimately, SMS helps to manage and lower costs by redirecting employees to localized, high quality settings of surgical care with access to an unmatched provider network that drive savings and impact the bottom line. Through effective engagement strategies, SMS’ Provider Alliance network, and access to quality patient care, SMS works with employers and health plans to ensure a positive and exceptional member experience.
Responsibilities
** The work schedule will be Monday - Friday from 10:30am - 7pm EST / 9:30am - 6pm CST **
As a Sr. Care Advocate Representative in the SMS Contact Center, you will be the face of Specialist Management Solutions (SMS) to our customers. You’ll deliver a personized, empathetic consumer experience as they navigate the complexity of the healthcare system. This will include answering questions and resolving issues in collaboration with teams across the company, healthcare providers, and insurance companies. You will be primarily engaging with our customers telephonically, but you will develop strong relationships with them as they complete their healthcare journey.
Essential Functions:
- Predominate amount of work surrounding calling members to inform them of their Specialist Management Solutions benefits and act as a care guide on behalf of the customer helping them receive treatment from a network of high-quality surgeons
- Receive inbound calls from members to educate them on their Specialist Management Solutions benefits and provide guidance with appointment scheduling
- Assist in the coordination of care across a variety of settings, while maintaining strict confidentiality and the highest level of professionalism
- Update all systems accordingly to document member engagement
- Accurately document appointments and update information accordingly
- Listen to member’s comments, concerns, and suggestions, relaying that information internally, while ensuring member satisfaction Collaborate with other departments and partnering companies as necessary Work with health insurance counterparts to answer customer questions related to benefits, claims, and billing
- Address and Analyze member inquiries, concerns, and complaints while providing information/solutions
- Work within a team to achieve performance targets
- Achieve individual Performance Metrics and Goals
- Adhere to attendance policy and expectations
- Participate in ongoing training and development
- Other responsibilities as assigned
Qualifications
- High school diploma or GED required; College degree preferred
- 3+ years experience in an office, call center, or administrative setting (healthcare preferred)
- Customer service / Sales experience is preferred
- Strong communication skills with the ability to build trust and express empathy
- Comfortable making outbound calls and engaging with individuals unfamiliar with the service
- Proven ability to meet monthly goals and performance metrics
- Reliable attendance and punctuality are essential
- Demonstrate professionalism, accountability, and a strong work ethic
- Able to stay calm and professional in high-pressure situations
- Experience using office tools and systems remotely (email, phone, CRM platforms)
- Self-motivated, organized, and open to feedback
- Bilingual (English-Spanish or other languages) a plus
USD $21.50/Hr. USD $21.50/Hr.
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