Member Assessment Agent

Johnson Service Group (JSG) is seeking a Bilingual Tagalog- Member Assessment Agent in the South San Francisco Area for a Health Plan partner. This position is working from home but may need to go into the office occasionally.

Working Hours: Monday -Friday 9:00 am- 5:30 pm

Pay Rate: $26.00-$32.00 per hour

This is a temporary contract assignment (approximately 3 months)

Bilingual English/Tagalog Required

General Description

This position conducts multiple outgoing calls. The main function of this role is to connect with members so that they can complete health risk assessment forms.

Responsible for conducting member assessments, educating members of plan benefits, and connecting members to community partner agencies and other community resources. The agent will work closely with various departments within the company to ensure regulatory compliance.

Duties & Responsibilities

Essential Functions:

• Conduct member assessment interviews and collect members’ health history, primarily by phone.
• Clearly document responses, risks, and any barriers to accessing proper care in company systems.
• Confirm receipt and validate completion of member assessments received via mail, telephone, fax, email, in-person, online, and external partners.
• Confirm member eligibility and special flag status, e.g., hospice status.
• Exhaust all resources and make robust outreach attempts to follow-up on open cases, including conducting member outreach by mail.
• Clearly document any member’s complaints, including grievances and appeals.
• Validate, research, and reconcile any discrepancies identified through various systems such as HEALTHsuite, and update member demographics as needed.
• Clearly refer and communicate pertinent health information to appropriate departments to facilitate assistance with the member.
• Participate in team meetings and contribute to quality improvement initiatives.
• Escalate member issues to Member Assessment Supervisor as appropriate.
  
  

Secondary Functions:

• Perform other duties as assigned.
  
  

Qualifications

The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position:

Education And Experienceequivalent To

• Equivalent to a high school diploma or GED required.
• Minimum of two (2) years of work experience in a healthcare or managed care environment.
• Experience working in a call center environment highly preferred.
  
  

Knowledge Of

• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
• Medicare and Medi-Cal programs highly preferred.
• Best practices in customer service, especially telephone-based services.
  
  

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law. #D800