Job Title: Customer service Representative (100% Remote) Location: Los Angeles, CA Duration: 3+ months with possible extension Shift Schedule: 1st shift Pay Rate: $29.80/hr. On W2 without benefitsJob Description:
- The Customer Solution Center, Even MORE, Service Liaison I will communicate to members in all lines of business (LOB) regarding welcome calls, outbound calls, member -Health Risk Assessment, and related programs by LOB. Conduct and document outreach activities (call, web, email) consistently and accurately. The Liaison will proactively identify, document, investigate, and resolve member issues in a timely and appropriate manner. The Liaison will also identify potential areas of membership dissatisfaction and recognize improvement areas. The Liaison is responsible for facilitating member enrollment and outreach efforts, with a focus on:
- Health Risk Assessment- ensure to meet all regulatory requirements for Centers for Medicare and Medicaid Services(CMS), and for SPD population.
- Contacting members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information was not provided on choice forms, enrollment applications, data transmissions from applicable sources, etc. as well as the preferred threshold language and/or alternative format for receiving their welcome kits, network-related member notification letters, etc.
- Collaborating with internal and external stakeholders and members to facilitate continuity of care and the related enrollments and assignments (based on enrollment information for Covered California, permission-to-enroll forms, daily updates from PASC, COBRA/ICP elections, etc.)
- Processing and screening applications and renewals for Healthy Kids members, notifying applicants of the disposition of their application/renewal, and conducting the appropriate follow-up (including review of vendor outreach efforts)
- Working with various internal, Plan partners, medical groups, etc. staff to address questions regarding member eligibility and demographic information.
- Collaborating with the Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, PASC, third-party liability constituency, etc. staff to address and resolve questions, and issues, etc. regarding member demographic information (e.g., CIN, name, address, and other related information) so that it can be appropriately updated and reflected in the system. Liaison also attends and participates in various internal and external meetings in this regard.
Role & Responsibilities:
- Facilitate the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communication, including welcome calls and meeting all regulatory requirements for Health Risk Assessments for CalMediConnect members and well as SPD members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This aligned with service level requirements. (40%)
- Even MORE Service Liaison will track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. Liaison will also assist with coordinating with other departments to follow up and resolve issues that arise through member contact, including potential care coordination/continuity of care issues. (20%)
- Liaison to meet XX P&P requirements for attendance and follow department guidelines and expectations. Collaborate with the CSC Departments regarding member enrollment efforts for all lines of business. (15%)
- Liaison will assist with identifying and assessing areas of potential member dissatisfaction (PQI) as well as focusing on opportunities for service/process improvement. This complies with regulatory requirements for auditing purposes. (10%)
- Liaison to assist Business Units and Product Lines with the implementation and completion of special projects, including member loyalty programs. Collaborate with internal and external peers to enhance the integrity of member information ensure continuity of care and increase member retention. (5%
- Perform other duties as assigned. (10%)
Experience Required:
- At least 0-1 years of customer service experience in a corporate setting.
- Managed care or healthcare experience.
Skills Required:
- Strong verbal, written, and communication skills.
- Strong organizational skills.
- Demonstrated experience handling complex customer calls.
What are the 3-4 non-negotiable requirements of this position?
- high school diploma or GED, home internet connection, customer service experience in a corporate environment call center experience, health care/managed care experience
Education Required:
- High School Diploma/or High School Equivalency Certificate