Member Engagement Guide

## **Company :** Highmark Health ## **Job Description :** **JOB SUMMARY:** This job collaborates with Sales Client Management and the Sales Executive team. The position will develop member transition strategies to steer the transition of members to AHN and community providers; thereby minimizing future member disruption. This position is responsible for educating members about how their insurance benefits work, the financial impact of healthcare choices, available provider/service options and the importance of getting the right care at the right time, in the right place. The incumbent will play a major role in driving change in member behavior and driving overall business outcomes from a cost of care perspective. **ESSENTIAL RESPONSIBILITIES:** - 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. **EDUCATION** **Required** - Bachelor's Degree in Business, Communications or related **Substitutions** - 6 years of related and progressive experience in lieu of Bachelor's degree **Preferred** - None **EXPERIENCE** **Required** - 3 years of prior sales or client consulting experience, preferably in the Insurance industry **Preferred** - None **LICENSES or CERTIFICATIONS** **Required** - None **Preferred** - Producer License in Life, Accident & Health **SKILLS:** - Strong relationship builder acro…