Case Manager Walmart Elective Benefits

Job Description

Consociate Health, a leading Third-Party Administrator, offers an opportunity to grow and develop your career in an environment that provides a fulfilling workplace for employees, and creates continuous learning and embraces the ideas and diversity of others.

As part of our Mission to make Healthcare more accessible and affordable for our clients through innovation solutions and expert consultation, we value the inherent qualities that are foremost in our Mission, Vision, Values- Compassion, Humility and Impact, which allow us all to create authentic relationships with our team and our clients.

Position Summary

The Case Manager is responsible for managing and facilitating service and travel navigation for members eligible for specialized benefits. This role ensures seamless coordination of care at top-tier medical facilities for cancer care, assists with benefit navigation, eliminates barriers, ensures access to quality care and resolves financial concerns. The position also oversees clinical travel operations and addresses member inquiries while maintaining service level commitments. This is a full-time position (40 hours per week) with a 7-day on-call rotation. This position reports to the Advanced Care Program Manager.

Principal Duties And Responsibilities

• Member Coordination: Serve as the primary contact for an assigned caseload, verifying eligibility, processing referrals and conducting initial outreach within 24 hours of referral submission.
• Navigation & Support: Educate members on benefits, assist with provider coordination and address travel and financial concerns.
• Issue Resolution: Handle billing, claims, eligibility and correspondence inquiries, escalating unresolved issues as needed.
• Travel Coordination: Arrange accommodations, transportation and relocation for members and caregivers.
• Process Improvement: Identify workflow gaps, provide feedback for enhancements and ensure compliance with service standards.
• Documentation & Reporting: Maintain accurate records of member interactions, travel activities and financial transactions.
• Performance & Compliance: Meet established efficiency, call quality and accuracy goals.
• Act as a resource for team members and assist in training new staff.
• Oversee case assignments, queue coverage, and on-call scheduling.
• Ensure compliance with policies and procedures while addressing process improvements.
• Attend team lead meetings and contribute to training development.
  
  

General Expectations

• Present a positive image of Consociate Health at all times.
• Provide and promote the delivery of services with a prevailing attitude of respect and recognition of the personal worth and dignity of every individual whether they are a customer or co-worker.
• Communicate in a clear and concise manner, while also demonstrating receptivity through active listening.
• Identify and perform work that has not been specifically assigned, as needed.
• Continuously seek opportunities for improvement and suggest ways in which procedures/systems may be modified to accomplish tasks/goal efficiently and effectively.
• Demonstrate a teamwork philosophy by working cooperatively with others.
• Attend required in-service and staff meetings.
• Seek other educational opportunities directly related to this position.
• Preserve the confidentiality of all business-sensitive information, including but not limited to that of insured groups and individuals, employees and applicants.
• Adhere to established safety standards and utilizes proper techniques to avoid work-related injuries.
  
  

Benefits

• Paid time off
• Paid Holidays
• Medical, Dental and Vision Insurance
• Basic Group Life, Short Term and Long Term Disability
• Voluntary Life, Critical Illness and Accident Coverage
• 401K Plan: Employees are immediately eligible with a 2% automatic enrollment. Consociate matches up to 4% of an employees' annual salary.
  
  

Required Experience

SERVICE EXPECTATIONS:

• Greet all people in a prompt and courteous manner. Communicate in a warm and courteous manner, making eye contact and speaking in a tone of voice that matches words.
• Ask customers what they need and strive to exceed their expectations. Offer and provide assistance whether or not the request falls within your specific job duties.
• Respond to customer requests in a timely manner consistent with Consociate Healths standards and best practices, return calls promptly and keep them informed of delays before they ask.
• Make decisions based on customer needs, opinions, complaints or suggestions.
• Take appropriate steps to resolve problems to the customer's satisfaction.
• Ask customers for their opinions, accepting criticism as an opportunity to improve service.
• Seek opportunities, provide value-added services, and eliminate tasks that do not serve our customer.
• Remain aware of products and services provided by Consociate Health.
• Project a positive, professional image when working.
  
  

Knowledge, Skills And Ability Requirements

• High school diploma or GED.
• 1-3 years of experience in customer service, travel, or healthcare.
• Ability to work independently and manage multiple tasks.
• Proficiency in Office 365, Adobe, and Excel.
• Ability to meet telecommuter requirements.
• Must be certified and maintain certification as a medical travel professional.
• College degree in healthcare, psychology, or a related field.
• 5+ years of relevant experience.
• Knowledge of medical terminology.
  
  

Keyword: Case Manager