Job Code
892

Department Name
Health Services

Reports To
Health Services Manager

FLSA Status
Non Exempt

Additional Compensation for Bilingual: $1,000/annually

Union Code
53A

Management
No

About Us:

Building Services 32BJ Benefit Funds (“the Funds”) is the umbrella organization responsible for administering Health, Pension, Retirement Savings, Training, and Legal Services benefits to over 100,000 SEIU 32BJ members. Our mission is to make significant contributions to the lives of our members by providing high quality benefits and services. Through our commitment, we embody five core values: Flexibility, Initiative, Respect, Sustainability, and Teamwork (FIRST). By following our core values, employees are open to different and new ways of doing things, take active steps to improve the organization, create an environment of trust and respect, approach their work with the intent of a positive outcome, and work collaboratively with colleagues.

The Funds oversees and manages $9 billion of dollars in assets, which are made up of many, varied and complex funds. The dollars come from a number of sources, including the property owners who pay into the funds on behalf of their employees, and as such, requires those who oversee and manage the money to be highly skilled financial management people.

For 2025 and beyond, 32BJ Benefit Funds will continue to drive innovation, equity, and technology insights to further help the lives of our hard-working members and their families. We use cutting edge technology such as: M365, Dynamics 365 CRM, Dynamics 365 F&O, Azure, AWS, SQL, Snowflake, QlikView, and more.

Please take a moment to watch our video to learn more about our culture and contributions to our members: youtu.be/hYNdMGLn19A

Job Summary:

This position is a key part of developing, expanding, and maintaining the Health Fund programs. The Health Services Patient Advocate is responsible for the maintenance of relationships with the 5 Star Centers, supporting the operations of the Health Fund Programs, responding to member and provider issues, and assisting members in choosing in-network providers, particularly 5 Star Centers and partnered providers. The Patient Advocate for Health Services addresses member concerns from the initial inquiry stage through resolution, engages in marketing strategies, and offers insights for ongoing quality enhancement of the Health Services Team. Furthermore, this role also contributes to various operational support tasks within the Health Services Team.

Essential Duties and Responsibilities:

Cultivate relationships with management and administrative staff at specified 5 Star Centers to assist in addressing member issues as they arise from the first inquiry to the resolution

Assist members with selecting appropriate providers based on medical criteria and scheduling appointments at 5 Star Centers

Review cases and directly communicate advantages of medical options while also addressing the limitations or alternative options available to members

Investigate member complaints and serve as advocates when a complaint is filed against 5 Star providers to determine a resolution

Investigate and identify any patterns and/or trends of Health Fund program issues with service provision and address accordingly or notify management

Address member concerns about Fund programs

Complete all program enrollment processes for eligible, interested members

Utilize Health Services Database to track interactions related to fund programs

Work with members and the providers to verify the correct copay and research claims to identify all billing errors

Handle and address cases involving out-of-network and non-preferred providers and offer members alternatives for in-network and preferred providers

Confirm if the provider is truly in-network or out-of-network, considering situations where providers may have varying statuses at different sites. Reach out to the provider's offices directly to verify their network status, location information, and participation details

Conduct research on uncommon procedures and verify the provider's capability to deliver services to effectively assist members in making intricate decisions regarding their transition of care

Perform side-by-side shadowing with new employees on all workflows, systems, and case management processes

Perform other tasks and special projects as required by management

Reach out to members and dependents who meet specific criteria for upcoming fund initiatives and our programs

Reach out to members who are unresponsive to third party administrators and vendors to ensure the correct process is followed from initial through completion of care

Handle escalated outreach requests

Receive incoming calls through the Health Services queue regarding Health Fund Programs, billing/claim issues and medical services

Direct escalated claim issues to management and Claims Specialist and relay the outcomes to members

Back up member services provider line queue upon request for provider search activity

Attend and participate in all team meetings

Log member issues into the department tracking system

Qualifications (Competencies):

Excellent organizational and prioritizing skills

Work on simultaneous projects with diverse working groups

Ability to clearly communicate ideas and thoughts

Work with minimal supervision and be an effective team player

Effectively work in a fast-paced environment, handle multiple tasks and prioritize work

Excellent listening skills and ability to address member concerns

Work well with physicians and other medical professionals

Think creatively and implement solutions to meet member needs

Navigate multiple systems simultaneously

Read, write and understand English is essential

Education:

High School Diploma
Associate’s degree or equivalent work experience in the healthcare industry
Microsoft Office with emphasis on Word and Excel
Strong knowledge base of healthcare industry and medical terminology
Insurance/managed care and claims processing background a plus

Language Skills:

Bilingual in English/Spanish is preferred

Shift

9:00 AM to 5:00 PM

Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.

Under 1/3 of the time: Standing, Walking, Climbing or Balancing, Stooping, Kneeling, Crouching, or Crawling
Over 2/3 of the time: Talking or Hearing
100% of the time: Using Hands

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

1/3 to 2/3 of the time: Work near moving or mechanical parts, exposure to radiation, moderate noise.

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