POSITION SUMMARY/RESPONSIBILITIES:

Serve as an advocate to assist and/or represent Special Health Care Needs (SHCN) which includes STAR Kids and STAR PLUS members on their behalf, in providing education and support to access necessary services. To include communication via correspondence as needed. This individual may work closely with the Service Coordination team and may facilitate mediation in cases of reported complaints regarding service coordination. They may also assist the member in accessing non-covered services, such as those provided in other social service or community programs. Additionally, they may be called upon to participate in other processes as needed. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies in regard to all aspects of operations within Member Services.

EDUCATION/EXPERIENCE

Bachelor’s degree in business, health care or related field with at least two years’ experience in the managed care industry is required. Minimum of five years’ experience in the managed care industry may be substituted for college education. Complaints and appeals resolution or quality improvement management experience as well as working with special needs population is preferred.