Job Description Summary

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The Patient Relations Representative serves as a trusted advocate and resource for CareMore patients, helping them navigate healthcare services, insurance coverage, and access to care. This role is responsible for delivering an exceptional patient experience by supporting patient engagement, resolving barriers to care, and collaborating closely with clinical and operational teams to ensure patients receive coordinated, high-quality service throughout their healthcare journey.
The Patient Relations Rep acts as a liaison between patients, providers, health plans, and community resources while supporting operational initiatives that improve patient satisfaction, retention, and overall care outcomes.

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How will you make an impact & Requirements

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Key Responsibilities

Benefit Navigation

• Serve as a primary point of contact for patients regarding insurance, benefits, and access-to-care questions
• Assist patients in understanding Medicare, Medicaid, and health plan benefits, eligibility, and coverage options
• Help resolve patient concerns related to appointments, referrals, billing, and care coordination
• Advocate for patients by identifying and addressing barriers to healthcare access and treatment adherence
• Educate patients on available public assistance and healthcare support programs
• Assist patients with applications and documentation for eligible programs and services

Patient Experience

• Support patient onboarding and orientation to CareMore services and programs
• Build strong relationships with patients and caregivers to foster trust and satisfaction
• Promote preventative care and encourage participation in health management programs
• Serve as a resource for insurance and benefit-related questions
• Participate in team meetings, case reviews, and patient experience initiatives
• Support organizational goals related to patient satisfaction, retention, and quality outcomes

Operational & Administrative Support

• Partner with clinic leadership and interdisciplinary teams to improve patient workflows and service delivery
• Support scheduling coordination, documentation, reporting, and operational processes as needed
• Maintain accurate patient records and ensure confidentiality in compliance with HIPAA standards
• Participate in quality improvement initiatives focused on patient experience and operational excellence

Community Engagement

• Partner with SHIP/HICAP to educate SHIP on CareMore resources and understand available to our patients/Medicare beneficiaries
• Identify key community organizations who can contribute to the overall wellbeing of our membership
• Participate in community outreach to support organizational net growth

Qualifications

Required Qualifications

• High School Diploma or GED
• 3+ years of experience in healthcare operations, patient relations, customer service, or care coordination
• Experience working with Medicare, Medicaid, or managed care populations preferred
• Strong communication, interpersonal, and problem-solving skills
• Ability to manage multiple priorities in a fast-paced healthcare environment
• Proficiency in Microsoft Office Suite and healthcare systems/platforms
• Comfortable with public speaking, possess effective presentation skills

Preferred Qualifications

• BA/BS in a related Field
• Bilingual skills preferred (Spanish)
• Experience in patient advocacy, community outreach, or health plan operations
• Knowledge of healthcare compliance and patient privacy regulations
• CA health insurance license

Core Competencies

• Patient-centered service
• Relationship building and communication
• Organizational and operational excellence
• Collaboration and teamwork
• Problem-solving and conflict resolution
• Adaptability and initiative
• Confidentiality and professionalism

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Compensation Range:

$29.04

to

$43.56

 

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.