Health Plan Associate

Be a part of the team building the future of healthcare!

Firefly Health is building a revolutionary new type of comprehensive health "care and coverage,” powered by a relationship-driven care team, a trusted virtual and in-person clinical network, and our proprietary technology platform.

Founded by experienced clinicians and technology leaders, Firefly Health is on a mission to deliver clinical and financial health through joyful, always there care. We are flipping the script on what it means to be a health plan and actually providing a true health benefit to members.

We are intensely focused on optimizing the physical + mental + financial wellbeing of those who want (and deserve) something better than the status quo. If you are ready to roll up your sleeves and take on our audacious mission, we would love to hear from you.

Your Role 

You will be responsible for navigating Firefly Health Plan members through their journey, beginning at sign-up, to help them understand our unique approach to healthcare and ensure they feel supported in understanding their benefits. You will become a Firefly Health Plan expert in our policies as you provide service to members, helping them to gain a thorough understanding of their health insurance and care. Your innovative side will be called upon to constantly be thinking of ways, both conventional and unconventional, to improve the member journey. 

As a Health Plan Specialist you will: 

• Provide knowledgeable and timely responses to our members via chat, email and phone to educate and assist them with the Firefly Health Plan 
• Assist members with questions regarding the Firefly Health Plan; Provider network, claims, benefits, medications, prior authorizations, Care-Key requirements, & Provider scheduling issues 
• Furnish benefits, claim status, eligibility checks, etc. to Providers on an Inbound and Outbound call & email basis
• Aide and guide members and Providers towards prompt resolution of questions and concerns 
•  Become an expert on Firefly's $0 version of a referral, known as a Care-Key, which will ensure the highest service to our members throughout the referral process
• Review and compare claims and data in order to resolve member and provider issues
• Educate and re-educate providers about the Firefly Health Plan, both proactively when a problem is noted and reactively when they contact us
• Create & submit single case agreements (SCAs) as needed for out-of-network care 
• Execute courteous, accurate, and prompt follow-up with customers by utilizing worklists to successfully manage daily tasks
• Carry out additional project work to support growth and scalability 

Things You Might Be Called Upon to Help With: 

• Project Management 
• Training new team members 
• Schedule and Lead Meetings 
• Assist Leadership to review and/or update department Policies and Procedures to ensure that they remain current and accurate 
• Split Shifts and/or Overtime IE: OEP/Customer Need 
• Cross-training with other Firefly Health teams to ensure customer needs are met 

You’d be a good fit if you: 

• Have 1-2 years of health insurance and customer service background 
• Have excellent communication skills and love delivering great service to people, often at stressful moments in their health journey 
• Have experience using digital technology to improve service delivery 
• Are patient, compassionate, positive, flexible, and willing to go the extra mile to get the job done 
• Are organized, thorough, detail oriented, and coachable 
• Have successfully proven remote-work time management skills 
• Ability to work both independently and in a team environment 

Our office is in Watertown, Massachusetts, but we’ve developed a robust remote working structure to give us more geographical flexibility while hiring for many positions. This role can be done largely remotely, there are several times a year when staff come together onsite for planning and team building. 

Firefly is an equal opportunity employer. We value diverse backgrounds and perspectives. We're committed to building and sustaining an inclusive workplace culture where individuals are treated with dignity and respect. All employment is decided on the basis of qualifications, merit, and business need. Firefly is an E-Verify employer.

We are always looking for valuable talent to add to our growing team. Even if you’re not sure this role is the one for you, don’t let that stop you. We’d love to have a conversation to see where you could fit.