Job Details

Job Title

This job is responsible for serving as a liaison between the member, the Health Plan, and the relevant state and/or federal regulators.

Job Description

The position conducts telephonic support to assess member needs, provide appointment scheduling assistance,and educating members of their rights and responsibilities. This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and externally.

Essential Responsibilities

Communicate effectively with staff, providers and members to accomplish business and member needs

Initiate outreach efforts, primarily by telephone, related to targeted preventive health initiatives:

• Perform member education functions on the importance of targeted preventive health service
• Recruit, holistically assess and enroll members into Disease Management Programs as appropriate
• Assess opportunity for Care Management intervention and make appropriate referral
• Contact members, providers and community agencies to coordinate access to preventive health services
• Tracks all member and provider contacts in the appropriate computer systems for the purposes of data collection and record keeping

Participate in the development of outreach programs that are effective, measurable and innovative, with a special emphasis on reaching at risk members.

Other duties as assigned or requested.

Education

Required: High School / GED

• None

Preferred: Associate's Degree

Experience

Required: 1 year in Community Outreach or Customer Service

• Familiarity with healthcare and/or insurance
• Experience working with the Medicaid and/or Medicare population

Licenses or Certifications

Required: None

• None

Skills

• Must be proactive, self-directed, assertive and creative in problem solving and system planning
• Strong active listening skills with the ability to act sensitively toward diverse people and situations .Ability to successfully interact with external customers, peers, colleagues, and management team
• Demonstrate effective time management skills and demonstrate an ability to prioritize and handle multiple tasks simultaneously
• Must demonstrate sound judgment and discretion when approaching problems and making decisions
• This position must be able to utilize sound and flexible productive work habits to set priorities, organize work and utilize time effectively
• Must be aware of issues members face related to healthcare including transportation, child care, lack of knowledge concerning preventive health, distrust of the system as well as other personal, social, financial barriers
• Must demonstrate patience and empathy when interacting with members and all internal/external customers
• This job requires the ability to work independently and as a team member

Language (Other than English):

None

Travel Requirement: 0% - 25%

Physical, Mental Demands and Working Conditions

Position Type: Office-based

Teaches / trains others regularly: Occasionally

Travel regularly from the office to various work sites or from site-to-site: Rarely

Works primarily out-of-the office selling products/services (sales employees): Never

Physical work site required: Yes

Lifting: up to 10 pounds: Constantly

Lifting: 10 to 25 pounds: Occasionally

Lifting: 25 to 50 pounds: Never

Pay Range

$19.66 - $27.42

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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