Responsibilities
General Description Act as the primary point of contact for members of CareAdvantage D-SNP and CareAdvantage CMC and assist members with all aspects of plan benefits. Duties & Responsibilities Essential Functions:
- Provide customer service to CareAdvantage members primarily on the phone.
- Answer member questions about CareAdvantage health and prescription drug benefits, eligibility, and provider network.
- Make New Member Welcome Calls.
- Resolve problems that members have accessing CareAdvantage-covered services, including but not limited to health care services and prescription medications.
- Ensure that assigned members retain CareAdvantage enrollment by investigating and contacting members and partnering agencies.
- Clearly document any member’s complaints, including grievances and appeals.
- Follow through with proactive solutions to resolve member issues.
- Prepare and submit requests for services made directly by a member to HPSM Health Services.
- Prepare and submit member requests for continuity of care with non-contracted providers to the Provider Services Department.
- Refer members to appropriate community partner agencies depending on specific circumstances including but not limited to: Behavioral Health and Recovery Services, Aging and Adult Services, Legal Aid and/or HICAP when appropriate.
- Relay pertinent health information to HPSM clinical staff to facilitate care coordination and/or receipt of medical services including prescriptions.
- Participate in and professionally represent HPSM at health fairs, community partnerships, meetings, committees, and coalitions as requested by the Manager or Supervisor. 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 experience equivalent to:
- Equivalent to a high school diploma or GED required.
- Two (2) to three (3) years’ experience performing customer service preferably in a health plan environment.
- Previous experience working with seniors or people with disabilities and/ in a medically related field such as medical assisting. Knowledge of:
- Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
- Health Insurance programs preferred.
- Customer service principles and practices. Abilities:
- Work cooperatively with others.
- Work as part of a team and support team decisions.
- Communicate effectively, both verbally and in writing.
- Adapt to changes in requirements/priorities for daily and specialized tasks.
- Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
- Perform problem research, use analytical skills, and effectively influence positive outcomes.
- Develop and maintain strong professional relationships with a diverse range of people.
- Utilize a personal computer, including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook). Desirable skills:
- Bilingual skills in Spanish, Tagalog, Mandarin, Cantonese, or Russian. Salary and benefits The starting salary range is $25.78 - $32.61 per hour, depending on the candidate’s work experience. Excellent benefits package includes:
- HPSM-paid premiums for employees’ medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
- Fully paid life, AD&D and LTD insurance
- Retirement plan (HPSM contributes the equivalent of 10% annual compensation)
- 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
- Tuition reimbursement plan.
- Employee wellness program It is HPSM's policy to provide equal employment opportunities for all applicants and employees.
HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law.
HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.
