Member Guide - Wall, New Jersey

We’re thrilled that you are interested in joining us here at the Amynta Group!

The Member Guide serves as an advocate and single point of contact for members seeking assistance with their healthcare and employee benefits. This is an in-office position, providing members with dedicated support as they navigate medical, dental, vision, voluntary, and employer-paid benefit programs. The position provides guidance on coverage, claims, providers, care options, and medications.

The Member Guide takes ownership of member inquiries from initial contact through resolution, coordinating with carriers, providers, and other partners as needed. A key responsibility of the role is connecting members with the most appropriate programs, resources, and care solutions available through their benefits package, helping them access high-quality, cost-effective care while improving both member experience and healthcare outcomes. What you’ll do

- Decide the best approach for each member. Assess each member’s needs, benefits, coverage and circumstances to determine the best path forward. Use your judgment to weigh available options, consider costs and coverage, and decide which resources or solutions are most appropriate for the member’s situation.

- Match members to the right point solutions. Learn the point solutions in each employer’s benefits package, such as cancer care, cardiac, mental health, diabetes and other chronic condition, musculoskeletal, fertility and second-opinion programs, and decide which one fits each member’s needs and coverage. Look beyond the immediate question to understand the member’s broader needs and determine which programs may provide the most helpful support.

- Help members understand their benefits and make informed decisions . Explain every part of a member’s benefits package in plain language: medical and pharmacy (deductibles, copays, coinsurance, out-of-pocket maximums), dental, vision, voluntary insurance such as accident, critical illness and hospital indemnity, and company-paid coverage such as life and disability. Teach members as you help, so they can use their benefits with confidence. Review how coverage applies to each member’s situation, explain available options and limitations, and help members understand the potential costs and next steps before making decisions.

- Find the best provider and care options. Identify doctors, specialists and facilities that fit the member’s needs, location and preferences. Verify relevant provider information, including network participation, availability and location. Steer members to lower-cost, high-quality options, including Centers of Excellence, preferred providers and lower-cost sites of care for imaging, labs and procedures. Compare available options based on quality, cost, convenience and the member’s needs, then recommend the most appropriate choice. Consider opportunities to help members access better care while avoiding unnecessary costs.

- Plan and coordinate next steps for members. Contact provider offices to book and confirm visits when needed. Look ahead to identify what else may be needed, such as referrals, follow-up appointments or additional support, and determine the best way to coordinate these steps so members can get the care they need.

- Resolve medication access problems. Work with pharmacies, prescribers and pharmacy benefit managers on denials, formulary exceptions, supply problems and refills. Assess the reason for the problem, determine the best way to address it, and work with the appropriate parties to pursue a resolution or identify suitable alternatives based on the member’s coverage.

- Determine how to move prior authorizations forward. Coordinate prior authorization requests, identify missing information from providers, and address stalled requests. Review what is holding up a request, decide what action or escalation is needed, and work with providers and health plans to resolve delays and help members access care.

- Take ownership of each case from start to finish. Manage member cases from the initial question through resolution. Respond by phone, email and the secure member portal, document decisions and actions, and follow through until the issue is resolved. Meet the response and resolution times established in Guided Health Concierge’s service level agreements (SLAs). Hand billing and claims issues off to Billing Guides. Set priorities, determine next steps, adjust your approach as needed, and decide when a case requires additional expertise or escalation. Take responsibility for moving each case forward rather than simply completing individual tasks.

- Identify patterns and recommend better ways to help members. Track recurring problems across the members you support, identify their causes, and recommend changes to workflows, procedures and member education. Look for common issues involving benefits, providers, access to care or member confusion. Consider why these problems keep happening and recommend practical changes that could prevent them improving the member experience or make the team more effective. Share your findings and recommendations directly with the Manager of Member Services and the Chief Client Officer.

- Share your knowledge and help improve how the team works . Use what you learn from complex cases and recurring member issues to suggest better ways to navigate benefits, use point solutions and communicate with members. Help colleagues work through challenging situations by sharing your knowledge and explaining possible approaches. Contribute ideas that help the team provide more consistent and effective support as the company grows.

What you bring

- 2+ years of experience in health insurance, benefits administration, a provider office, a pharmacy, or healthcare customer service

- Working knowledge of health plan terms, including deductibles, copays, networks, EOBs and prior authorizations

- Empathy and strong communication skills (written and verbal), including with stressed or frustrated members

- A proactive mindset: you anticipate what a member will need next, and you keep at an issue until it’s fixed, even when that takes several calls

- Sound independent judgment and the confidence to decide the right course of action for each member

- Strong organization and the ability to manage many open cases at once

- Comfort with computers and learning new systems, including Microsoft Office or Google Workspace

- An understanding of HIPAA and how to handle protected health information

- Bachelor’s degree required
The Amynta Group (the “ Company ”) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of any ground of discrimination protected by applicable human rights legislation. The information collected is solely used to determine suitability for employment, verify identity and maintain employment statistics on applicants.

Applicants with disabilities may be entitled to reasonable accommodation throughout the recruitment process in accordance with applicable human rights and accessibility legislation. A reasonable accommodation is an adjustment to processes, procedures, methods of conveying information and/or the physical environment, which may include the provision of additional support, in order to remove barriers a candidate may face during recruitment such that each candidate has an equal employment opportunity. The Company will accommodate a candidate to the point of undue hardship. Please inform the Company's personnel representative if you require any accommodation in the application process.