Evry Health

Bilingual

• Communicate and provide education to members and providers on insurance plan benefits and digital health solutions.
• Use negotiation and motivational interviewing techniques to increase engagement.
• Pro-active and reactive support for members, including outbound phone/email/text outreach.
• Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement.
• Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls.
• Accurately track and document work on a variety of internal software tools and platforms.
• Consult with supervisors, utilization management team, medical directors, as needed to overcome barriers.
• Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
• Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals.
• Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care.

Bilingual Care Coordination, RN

Data Analyst

• Data Extraction and Management: Pull health plan, member, provider, and operations data from various sources and databases using SQL.
• Data Analysis: Analyze large datasets to identify trends, patterns, and discrepancies across different types of operating data.
• Reporting and Visualization: Create reports, dashboards, and visualizations to present complex findings in an accessible format for both technical and non-technical audiences/stakeholders.
• Collaboration: Work with teams across the company to manage different types of data requests and to implement and evaluate data-driven solutions.
• Data Quality: Ensure data integrity across our systems by identifying discrepancies and recommending/implementing data capture and maintenance standards/processes.

Business Data Analyst – Commercial Health Insurance

Actuary

• - **Reporting and Analysis:** Assist with report development and analysis (pricing/experience/trends) that helps to inform the actuarial side of the business.
• - **Risk Assessment:** Evaluate and analyze health insurance applications to determine the risk they pose, helping to set premium rates that are both fair and competitive.
• - **Claims Analysis:** Interpret and analyze underlying claims experience to inform underwriting decisions and policy adjustments.
• - **Policy Development:** Assist in the development of insurance policies or suggest changes to existing policies that balance the needs of market with the risk to the insurance company.
• - **Regulatory Compliance:** Stay updated with changes in legislation and regulations that may affect the product design and underwriting considerations.
• - **Quote Requests:** Assist with the management of quote requests.
• - **Documentation:** Maintain accurate and detailed records of policies underwritten and decisions made, tracking concessions and experience.

Bilingual Care Coordination, RN

Business Data Analyst – Commercial Health Insurance

Junior Actuary – Commercial Health