The OccuNet Company

Advocate

• Serve at the forefront of The OccuNet Company’s experience-centric approach.
• Provide members with exceptional support by delivering high-quality, professional, and efficient service across multiple channels.
• Liaise with members and providers to resolve inquiries and assist in the navigation of Reference-Based Pricing (RBP) health plans.
• Uphold best-in-class member experiences by owning the end-to-end resolution process.
• Practice TOC’s “outward mindset” philosophy through providing empathic support to members.
• Service members as they navigate their employer-sponsored healthcare plans by quoting benefits, interpreting plan documents, and answering questions regarding claim status.
• Service providers by providing eligibility verification and answering questions regarding claim status and pricing inquiries.
• Work across cross-functional teams to establish processes that relieve challenges members are facing.
• Uphold compliance and confidentiality standards relating to HIPAA when corresponding with members or providers.

Member Benefits Advocate

Implementation Specialist

• Serve as the primary point of contact for all implementation-related activities throughout project lifecycles.
• Lead end-to-end implementation activities for new client implementations, TPA integrations, client migrations, and program implementations. Effectively transitions the client relationship post-implementation to Account Management.
• Develop and maintain detailed implementation plans, timelines, milestones, and deliverables.
• Proactively identify risks, dependencies, and potential roadblocks.
• Facilitate implementation meetings, status reviews, and project communications with internal and external stakeholders.
• Anticipate project risks and dependencies, developing mitigation strategies to minimize disruptions, and drive accountability among project participants to ensure timely completion of tasks and deliverables.
• Ensure all implementation requirements, configurations, testing activities, and deliverables are completed accurately and on schedule.
• Evaluate the impact of client-requested exceptions and develop reasonable alternatives to satisfy client’s needs while minimizing impact on the organization’s systems and operations.
• Assess gaps and recommend enhancements related to new and/or existing products, services and workflows based on a broad view of the organization.
• Identify opportunities for cross sales of additional products and services throughout the implementation process.
• Contribute to the development of new or updated implementation tools, resources and materials.
• Participate in the development and introduction of new products, identify the potential impact to workflows and the overall implementation process; May be responsible for defining, developing and implementing new or redesigned process workflows in support of new products.
• Solicit and assess internal and external customer feedback to enhance continuous quality improvement on the implementation process (i.e., systems, resources, tools, etc.).

Director, Client Implementations

Pharmacist

• Support pharmacy benefit operations by coordinating clinical and administrative workflows.
• Review documentation and communicate with members, providers, pharmacy staff, clients, and internal stakeholders.
• Ensure accurate, timely, and compliant processing of pharmacy benefit requests while supporting service quality and operational efficiency.
• Support the clinical team in prior authorization case reviews and administrative tasks related to prior authorizations and appeals.
• Assist member services, members, healthcare providers, and internal stakeholders with claim resolution, coverage questions, formulary questions and pharmacy benefit determinations.
• Perform other assigned duties and assist with special projects.

Member Benefits Advocate

Director, Client Implementations

Clinical Associate – Pharmacy Technician Certification Required