Becoming Concierge: Who, What, Why

To understand the bigger picture of who Healthcare Concierges (HCCs) are, what their role is and why it is important.

Who Are Concierge?

The Role

HealthJoy's Healthcare Concierge (HCC) team is at the front line of all customer interactions. As an HCC (Health Care Concierge), it will be your responsibility to ensure that the customer is given the proper level of care, based on their expressed and unexpressed needs. 

Because of the nature of our business, it it vital that all HCCs become an expert in: 

  • US Healthcare
  • Healthjoy Products & Services
  • Understanding our customers' needs

 HCCs should engage in Active Listening, whether via phone or chat. 

What Do We Do?

Assisting the Customer: Fulfillment

The act of engaging our customers with Healthjoy products and services is called Fulfillment. Think of fulfillment as anything the Concierge team does to advocate for the customers' needs. 

There are 3 stages to Fulfillment:

  • Stage 1: Intaking 
  • Stage 2: Completion (fulfillment)
  • Stage 3: Communication

 

It is important that all front line HCCs (stage 1) be an expert at Healthjoy's products and services along with a critical expertise in knowing and understanding insurance and people. ​This expertise, along with strong comprehension skills, will ensure your success in this role. 

You will learn more about the Fulfillment process later in your training. 

 

 

​Stage 3

Communication- This occurs when the result of the Fulfillment request is communicated to the customer (typically occurs via an outbound chat).

Competency Overview

By the end of your training you will understand what services Healthjoy offers to our customers and the knowledge that you, as an HCC, will need to become an expert on. ​Using your expertise you, will be able to quickly assess a customer's need and navigate them to the best possible solution. 

See below for a list of the common customer needs, and the resources available to assist. Don't be overwhelmed, this will be second nature to you very soon. :)

  1. Understanding/Using medical insurance benefits

    • Cost of procedures (copays, ded, etc)

    • Explain insurance benefits 

    • Coverage of procedures/services (incld any authorizations that may be needed)

    • Cost of medications (RX ded, copays, tiers, etc)

    • Scheduling appts

    • Medical Bill Review to help understand dr/hospital charges and customer responsibility

    • Explaining insurance cycle of enrollment (sales, app receipt, payment, card receipt, renewal)

  2. Provider Network Status

    • Locate in network providers

    • Confirming network status of preferred providers

    • Advising of in network vs out of network benefits

    • Designating PCPs (HMO/POS)

  3. Receiving Low/No Cost Medical Care

    • Locating local clinics that bill on a sliding scale (according to income)

    • Researching programs that cover Rx for diseases/chronic conditions such as:

      • HIV/Aids

      • Diabetes

      • High Blood Pressure

    • Healthjoy/MeMD Telemed services

    • Locating local retail pharmacies that offer Minute Clinic services for acute conditions

    • Medical bill review to negotiate lower out of pocket costs

    • Lab discounts

  4. Saving Money on Prescription Medications (Rx)

    • Researching Rx manufactures for discounts/coverage

    • Contacting retail pharmacies directly for cash prices of medications

    • Searching Goodrx.com for applicable discounts

    • Search UNA (HII customers only) for applicable discounts

    • Rx Optimization to find lowest cost Rx under insurance in addition to discounts

  5. Health Maintenance

    • Telemed

    • Health Chat

  6. Ancillary Savings

    • Dental discount programs

    • Vision discount programs

    • Laboratory discount program

Getting to Know the Customer

Getting to Know the Customer

Similar to Fulfillment, there are 3 key competencies that a Stage 1 HCC must possess in order to act in the best interest of the customer and show the most value in the magic of Healthjoy. 

  • Understanding Insurance (Medical & Dental)
  • Understanding Healthjoy products & services in depth
  • Understanding PEOPLE

As HCCs, our role is to fact find to the root of the customer's needs through a series of clarifying questions and statements. This requires HCCs to have a working knowledge of Healthjoy's products/services, insurance expertise and the art of understanding people. 

Later in your training, you will learn more about the process of fact finding and understanding our customers and their needs. 

 

Applying the Role

Bringing it Together

Now let's examine a scenarios where value can be added to the interaction that we have with our customers. 

​Scenario 1

A customer on a short term medical plan chats in and says,

Now let's say the customer's response was: 

Value in fact finding

  • On a short term plan, if a customer is seen for anything other than a new injury or illness, the intended visit will not be covered.
  • The customer may have some minor concerns that can be treated using Healthjoy's Telemed/Health Chat service, instead of paying for a visit.   

Had no additional fact finding been done and we sent the customer to an in-network physician, there is a possibility the customer may have initially been happy with the service, until they later received a bill for a visit they thought was covered. 

It's best to eliminate any potential for unexpected costs, wherever possible. This can only be done through an assessment of the customer's needs.