Insane Role - Very Uncomfortable Place to Be
Pros
Get to learn about managed care, insurance pools, stars and service quality, presenting relevant information to members, partners, government officials, law firms, DME, PBMs, other third parties, interpreting and applying medical policies, understanding medical devices, pharmaceuticals, medical suppliers/DME, reading lots and lots of contracts, various authorizations, international coverage and moving bodily remains, authorizations, reasons for limiting IP stays, deliveries, ACA's provisions, abortions, self-insured plans, complaint handling, emergencies, medical errors, competing health systems, HIPAA, balance billing, system capacity issues and scheduling, current health condition trends and wellness programs, knowing and using medical terminology to communicate with experts, pharmacists, mental health specialists, and nurses, matching credentials with services and medical diagnoses provided, understanding financial accounts and how they work with health plans, accumulations, requesting daycare billing, how to operate these products, coordination of benefits, STEP Rx, anti-vaccine callers, transplants, genetic testing, FWA, experimental clinical trials, what to do with people who desperately need financial and/or health services right now, how to work with translators, advocate for members who don't understand what's happening, and much much more. Truly, much much much much more... Company provides training for three months, and then expects you to apply this information to all the scenarios that you have never thought of or dreamed existed. Can be incredibly boring to incredibly intense in a matter of seconds. Every click of the mouse, breath in the mic, and button you press will be recorded to see how you react (not respond) in any and all scenarios. Common sense, use of "evidence" and expert advice before making decisions is necessary. Insanely high expectations for servicing members and broader community. Nice members. Knowing it's not just you. Most people struggle, and most people either find a new role outside the company or are let go within a few years. Your skills and educational background must closely match internal company roles. Otherwise, there is little to no career advancement. Excellent match and health insurance. If you do not have a degree, it's ok. There's a standardized test that you take before the interview round. The department recruits nationally, because they want the best. Some reps had graduate degrees and some reps had GEDs.
Cons
The above. We are not computers. This is an almost impossible job, especially with the quotas, upbeat demeanors, and QA checks that ensure everyone stays on their toes! (Incredible nitpicking. Cube neighbor said she worked in call centers for the past 14 years. This is NOT a call center. It's something else entirely. I also went to the ER where the ER person said she worked in this role. She said it was an experience she'd rather forget. The ER was more manageable and had a more supportive environment.) Some of us could not afford to live on the salary ($40k) where the state median is $55k and average is $70k. Also, some of the scenarios were traumatic. People were dying, broke, and were in significant pain or suddenly dying. Really weird and radical things showed up, because it's insurance. There was no support or dialogue about these tragic situations. The department never granted more than one day off at a time due to "demand for vacation" from other people. There was never an opportunity to go to the onsite pharmacy, or to attend a yoga or meditation class on the lower floors. I worked in a department full of desensitized managers where this was just another weird drop in a bucket. Some managers are great. However, some should never be responsible for another person's well being. The animosity and internal politics among some managers were jaw-dropping, especially in a healthcare organization where you'd want to see great outcomes, not high turnover. At times, it looked like managers might want to physically hit their employees for not meeting standards during call reviews. Some stated they thought an employee was stupid and another belittled the employee's efforts to improve. Terrifying.
