Job Description

Job Description

Job Description

Description:

The Healthcare Concierge should have relevant customer service experience, preferably with Medicare experience and specifically with Medicare Advantage programs and familiar with PPO’s and HMO’s. Must have strong oral and written communication skills, planning and problem-solving skills and be skilled in personal diplomacy. The applicant must possess a high level of motivation, professionalism and ethical conduct and place a premium on treating others with dignity and respect.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Receive all inbound calls from the member population and conduct proactive outbound calls as assigned
• Address member concerns and answer questions related to claims issues, provider resources, benefits, billing, member enrollment/disenrollment and service issues
• Resolution and timely response to all member problems within expected or required timeframes
• Adhere to set Member Services call center metrics and call evaluation requirements including, but not limited to set monthly call volume, call quality scores, abandonment rates, CMS service levels, and missed/refused call volume.
• Assist with responding to member inquiries via email, US Mail, and in-person
• Maintain personal metrics to established performance levels of the team
• Management of the customer relationship to ensure retention and maintain member loyalty
• Provide member education and counseling on access to services, benefits, and providers
• Assume ownership and responsibility for member satisfaction with HealthTeam Advantage
• Maintain completion of special projects, as assigned. This includes, but is not limited to member outreach, follow-up, etc.
• Assist in grievance and appeals process
• Perform verification calls for members that have enrolled in the HealthTeam Advantage plan as well as perform welcome calls to those members that do not require a verification call
• Perform outreach calls for members that have enrolled and require provider attestation or HRA completion.
• Ability to work before/past normal shift hours to complete any outstanding tasks for a member(s).
• May have to work mandatory overtime during certain timeframes in the calendar year (i.e.: AEP, Quality Measure initiatives other special projects)
• Ability to work in retail space, Local Benefits Center (LBC) 8:00 AM- 4:00 PM- Monday through Friday.
• All other duties as assigned.

EDUCATION AND EXPERIENCE

Education:

• High School diploma, GED, or equivalent work experience

Required Experience:

• Customer service, sales, or account management experience
• Call Center/ High call volume handling experience
• Managed care or health plan operations experience

Preferred Experience:

• Healthcare Concierge experience
• Medicare Experience

KNOWLEDGE, SKILLS, AND ABILITIES

Required Competencies:

• Call Center/Customer Service Experience
• Excellent problem-solving and organizational skills
• Strong interpersonal communication skills
• Excellent knowledge of Microsoft Office (Excel, Word, PowerPoint)
• Ability to work independently or as a team
• Operate general office equipment, including but not limited to computers, phones, copiers, postage machines, and related devices

Preferred Competencies:

• Thorough knowledge of CMS guidelines, processes, and systems

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