Health Pro Consultant - US Virtual

Role OverviewHealth Pro – Case Management Advisor in the health benefits area.ResponsibilitiesReceive extensive health care and case management training to support members on complicated healthcare matters.Your primary responsibility is to be an advocate for members requiring guidance across the health benefits environment. Activities include, but are not limited to:Gathering information about the reason the customer is seeking support or care.Educating members on benefit programs provided by clients.Translating complex benefit details (e.g., deductibles, coverage limits, prior authorizations) into clear, actionable guidance members can understand.Delivering provider recommendations, referral guidance, and connections to clinical or employer-sponsored programs to support informed care decisions.Completing cost estimates and communicating out-of-pocket responsibility, claim results, denials, appeals, and escalation outcomes with accurate expectations and timelines.Explaining prescription formulary options, prescription alternatives, prior authorization outcomes, and available cost-saving opportunities.Proactively identifying unmet clinical needs and owning the connection to appropriate clinical support and care resources.Connecting members to company-sponsored health and benefits programs for specialized care.Providing proactive, timely updates via phone and digital channels and ensuring members feel supported through full case resolution.Navigating medical bill review results, including identified errors and savings achieved, and translating findings into clear, actionable guidance for members.Drafting carrier and client appeals for healthcare services.Coordinating records transfers and authorization requests that require pre-service approval.This work involves leveraging developed methodologies, navigating internal tools and applications, as well as making external phone calls, partnering with carriers and providers (via email and phone outreach) to resolve member needs.You will interact with members through incoming calls, emails, and messaging system interactions, utilizing exceptional communication, empathy, and problem solving skills to understand and solve complex customer needs.Required QualificationsMinimum of 2 years of experience in a medical assistant/medical support role, or 3 years of experience working in a customer-facing role within the healthcare industry.Ability to work effectively in a remote team environment.Strong listening, reasoning, and analytical skills – ability to listen to members' needs and dig deeper to understand the root cause of their concern with empathy.Exceptional verbal and written communication skills – can convey complex concepts, both verbally and in writing, to members who are not benefits experts.Strong ability and desire to learn continually in a changing environment.Exceptional critical thinking and problem-solving skills.Ability to efficiently organize work activities to meet deadlines.Passion to provide the highest level of client satisfaction.Ability to receive and immediately apply constructive feedback.Ability to develop effective rapport with clients based on empathy and trust.Proficiency in MS Office suite.BenefitsBenefits include health, dental, and vision coverage from day one; wellbeing programs; retirement plans with matching contributions; generous time off; parental leave; continuing education; and career growth opportunities.Equal Opportunity EmployerAlight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state, or local law. The company takes affirmative action to employ disabled persons, disabled veterans, and other covered veterans.Reasonable AccommodationsAlight provides reasonable accommodations for individuals with disabilities as part of the hiring process. Applicants who need accommodations may contact the recruiter or send an email to alightcareers@alight.com.Authorization to WorkApplicants must have work authorization in the country of application that does not require future visa sponsorship.SalaryPay Range: Minimum $50,000.00 – Maximum $50,000.00 USDDISCLAIMER: Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.J-18808-Ljbffr