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Kaiser Permanente Careers

Customer Service

Making Each Interaction Extraordinary

Functioning as a liaison between our members, employer groups, providers, brokers, and internal customers, our customer service groups are the face and voice of Kaiser Permanente. They play a vital role in explaining our offerings, policies, and procedures as well as meeting the needs of our members across the country.

Expert Advisor

Location: Rockville, MD Additional Locations:
Job Number: 793355 Date posted: 05/14/2019
Description:

KP members within a choice (POS/PPO/OOA) plan require an additional degree of assistance understanding their plan and navigating between in network and out of network services. Often, these patients require hands on assistance in finding providers and pharmacies in select locations, understanding resources available to them like kp.org and our mobile app, and the best way to use their insurance plan. The Expert Advisor role is critical to ensure that members are provided a good on boarding experience, have their needs met, and receive the highest quality of care.



Essential Responsibilities:

  • The Expert Advisor supports new member engagement, growth and retention of members in the region by:

  • Acts as a new member ambassador by ensuring that members understand the plan they purchased, understand the value of Kaiser Permanente care, integrate into the KP delivery system, and know how to get started using the provider directory to find doctors, facilities, and pharmacies.

  • Assists members in problem solving potential issues related to health care delivery or financial barriers.

  • Performs provider searches and emails members information they need to access care.

  • Acts as a 'navigator' between in network and out of network services so members understand, referrals and precertification, covered benefits, and claim submission procedures.

  • Schedules select medical appointments or consultations with pharmacy teams.


  • Documentation and information coordination on behalf of members or internal and external entities including issue tracking through escalation.


  • Owning the primary escalation path for members by working with clinical staff and business partners across a variety of internal (Appointment Centers, Claims, Membership Services, Pharmacy, Care Delivery, Referrals and Precertification) and external entities (TPAs, Providers & Provider Networks, Directories) to ensure care and plan administration needs are met.

  • Providing support to members with complex network or product administration needs.

  • Providing one-contact resolution to escalated member concerns that require the application of considerable discretion and independent judgment to evaluate various courses of conduct, formulate solutions, and resolution.

  • Identify, analyze & report trends and/or systematic issues as they become apparent. Provide consultation and recommendations to management around process.

  • Basic Qualifications:

    Experience

  • Minimum four (4) years relevant experience required.

  • Education

  • High School Diploma or General Education Development (GED) required.

  • License, Certification, Registration

  • N/A



  • Additional Requirements:

  • Experience interacting with members and customers required.

  • Familiarity with medical terminology, benefit interpretation, and authorization/precertification of service.

  • Excellent written and oral communication.

  • Organized and able to manage competing priorities.

  • Good judgement, resourcefulness, and problem solving skills.

  • Strong documentation and computer skills.

  • Works independently with little supervision.

  • Forward thinking to predict member needs.

  • Able to follow through with delegated tasks and accountabilities.

  • Dedicated to helping members and customers.

  • Strong customer service focus.

  • Ability to coordinate multiple components of care.



  • Preferred Qualifications:

  • POS/PPO/OOA Insurance or Health Insurance Administration experience preferred.

  • Provider network experience preferred.

  • Medical office operations, Appointment Contact Center, or Member Service Contact Center experience or exposure preferred.

  • Ability to explain the KP value proposition during conversations with members preferred.

  • Previous member/patient navigator or care coordination experience preferred.


  • Bachelor's degree in related field preferred.
  • Primary Location: Maryland,Rockville,Rockville Regional Offices 2101 E. Jefferson St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon - Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Non-Union, Non-Exempt Job Level: Entry Level Job Category: Customer Services Department: KPIC/ Case Installation Travel: Yes, 10 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About Customer Service Careers

    Customer Service Careers

    With over 11 million members, more than 127,000 employees, and over 40 million doctor visits a year, our customer service teams need you to come work with a wide variety of people to address concerns, resolve grievances, and educate our communities about our offerings. At Kaiser Permanente, you'll put your communication and mediation skills to work in support of excellence. We are committed to supporting you with ongoing growth, training, and development opportunities.

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