Job Qualifications
Education
- Associate degree in, education, communication, or health related field or equivalent work experience
Experience
- 2 years - Experience in a customer service support role is required
Skills\Certifications
Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and
accountability.
- Proficient interpersonal and organizational skills
- Independent, Sound decision-making and problem-solving skills
- Must be able to work in an independent and creative manner.
- Self-motivated and able to manage multiple tasks and set priorities.
- Effective time management skills
- Excellent oral and written communication skills
- Strong interpersonal and organizational skills
- Knowledge in Medical terminology
Responsibilities:
Job Profile Summary: Supports area clinical team and serves as a proactive resource for members related to disease prevention and benefit education.
Job Responsibilities:
Conducting educational telephone calls advising members of available benefits, services and programs; completes health
needs assessment, and refers members to population health management programs as appropriate.
Reaching out to members with identified gaps in care; encouraging and motivating them to become compliant; offering
assistance in locating providers and appointment scheduling.
Managing system work queues; screening identified members for eligibility, prior case activities, recent claims, customer service inquiries and authorization history; assigning members to clinical team for call outreach and intervention.
Facilitating research and analysis of inquiries and/or complaints related to processes and designations, member lost incentives,
and other program related inquiries.
- Work overtime as needed
- Various immunizations and/or associated medical tests may be