Member Engagement Guide

at  Highmark Health

SKILLS:

• Strong relationship builder across multiple levels of an organization from employee through senior leader
• Strong communication and influence skills across levels of an organization from employee through senior leaders
• Able to work effectively in a matrix environment
• Able to juggle and manage competing priorities
• Strong presentation and written communication skills
• Strong analytical skills /financial acumen

POSITION TYPE

Office-based
Teaches / trains others regularly
Frequently
Travel regularly from the office to various work sites or from site-to-site
Constantly
Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Never
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

• Empower members to make informed decisions by evaluating the most appropriate type of provider for members’ unique needs, assess which providers are in-network and ensure that the members are fully informed of the tools and resources available to transition to AHN or other community providers.
• Advocate for the member by providing assistance with transferring medical records, making prompt appointments with AHN or other community providers and providing assistance with resolving claim or billing issues. Educate members about access to comprehensive clinical care and demonstrate the quality of care and advanced outcomes of partner network providers. Assist members in engaging medical care from higher quality, more cost effective providers closer to their homes. Create new and innovative opportunities for members to interact with patient-focused providers and experience the quality of care first hand for various specialties. Showcase the latest developments in quality of care and the results of investments from AHN and community partner providers.
• Demonstrate business acumen by partnering with, and developing proactive sales strategies with the Organization’s Sales team and executing these strategies by influencing member buying decisions at enrollment events focused on not only maintaining enrollment but increasing the Organization’s enrollment and profitability.
• Participate in the development of sales strategies with the Organization’s Sales Team, as well as executing those strategies in sales situations by influencing member buying decisions to purchase supplemental Lines of coverage for growth and/or retention of contracts and increase profitability for HMIG products along with the dental and vision companies on a regional and national basis. Activities include, but are not limited to, scheduling and facilitating meetings with employers, members and AHN and community provider partners.
• Identify and research operational issues based on member/client feedback and transition details to the appropriate internal department (including but not limited to Product Management, membership, claims, eMarketing, etc.). Identify any opportunities for process improvements. Success will be dependent on partnering with the appropriate subject matter experts in diverse areas of the enterprise
• Drive changes in member behaviors by developing strategies that influence change and create action from benefit executives and individual members, including development of incentive models, creating connections and relationships between executives at the Organization, employer organizations and demonstrating the financial impacts of decisions for employers and members.
• Other duties as assigned or requested.