Participant Advocate

The Participant Advocate is responsible for helping participants navigate the health care system by serving as an intermediary when non-eligibility carrier issues become escalated. He or she possesses detailed knowledge of clients health plan provisions and can effectively communicate with health plans and participants to assure the highest level of service and benefits. The Participant Advocate possesses the analytical evaluative skills of a claim examiner and the interpersonal acumen of a skilled customer service representative. An Advocates is also responsible for providing the client, client team, and carriers with trend analysis, regular reporting, and process improvement recommendations.

Work with Participants:
When other means have failed, participants rely on the expertise of an Advocate to engage in more extensive inquiry of a claims or access health care issue. Due to the potentially confidential nature of issues handled by the Participant Advocate, careful discretion must be used when collecting, discussing and documenting information. This individual must possess in-depth knowledge of potential liability issues and conduct research within appropriate boundaries. The Advocate collects pertinent information from participants, documents the information concisely, conducts thorough research and follows up with participants within the appropriate timeframe. Excellent customer service skills are essential.

Work with Health Plans:
Utilizing his or her expertise of vendor operations, the Advocate works closely with key carrier contacts to resolve participant issues. Vendor management is important in achieving mutually agreeable outcomes. Superior communication skills are required to effectively influence change.

Work with Client Teams:
An Advocate acts as part of a client team to resolve individual participant issues. Additionally, a Participant Advocate is responsible for identifying current carrier trends. Advocates work closely with team management to communicate global issues to the team. This may involve additional team training, or broadcasting of team wide messages.

Work with Client:
Each client team will be responsible for reporting data to the client on a regular basis. The Participant Advocate will use the workstation tools necessary to gather key data for regular reporting. Additionally, Advocates will report urgent issues to the client as needed. Upon client request, Participant Advocates may be called upon to provide background information to the client when ERISA appeals have been initiated. The Advocate must partner with the client and anticipate future needs.

Work Hours: 9:30 am - 6:00 pm
REQUIREMENTS
Technical Knowledge Required to be Proficient in Role
Detailed knowledge of, and experience in, health plan claim processing and customer service functions
Thorough knowledge of client plan provisions
Reliable, consistent research and follow up skills
Superior verbal skills and effective use of advanced customer service principles
Effective use of workstation functionality (e.g., TBA System, Plan Reference, Workflow)
Well-developed problem-solving skills



Hewitt Associates is a global outsourcing and consulting firm delivering a complete range of human capital management services to companies, including HR & Benefits Outsourcing, Payroll, Health Management, Retirement & Financial Management, and Talent & Organization Consulting.

Our associates have been instrumental in developing innovative solutions that have helped our clients become some of the most successful companies in the world. Today, our client roster includes more than half of Fortune 500 companies and more than a third of Fortune Global 500 companies.