Member Experience Specialist

Location: Marquette,Michigan,United States

POSITION:  Member Experience Specialist

DEPARTMENT:  Strategic Initiatives

BASE RATE: $20.41 per hour, with potential for additional compensation based on qualifications. 

POSITION SUMMARY: 

This position coordinates and prepares external communications for Upper Peninsula Health Plan (UPHP) members and providers. This position also facilitates government program enrollment and membership activities including grievance resolution. The Member Experience Specialist completes tasks and duties in accordance with established goals, objectives, and standards of the Upper Peninsula Health Plan.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Follows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential information. 2. Maintains knowledge of regulatory communications and marketing guidance including, but not limited to, Centers for Medicare and Medicaid (CMS) Managed Care communications and marketing guidelines, CMS plan communication user guide (PCUG), and Michigan Department of Health and Human Services (MDHHS) marketing requirements and guidelines.  3. Develops and coordinates interdepartmental reviews of major member materials such as Annual Notice of Change (ANOC), summary of benefits (SB), enrollment and disenrollment documents, member handbooks, and newsletters; responsible for the development and submission of member materials for all UPHP lines of business.  4. Conducts member outreach as needed.  5. Coordinates Medicare enrollment/disenrollment processes. Ensures enrollment process timeline parameters are met and daily Transaction Reply Reports (TRR) are addressed timely. 6. Responsible for investigation and timely resolution of member grievances for all lines of business. Compiles data, analyzes, and drafts grievance reports for CMS, MDHHS, and Department of Insurance and Financial Services (DIFS).  7. Processes returned member mail in accordance with applicable rules and regulations.  8. Reviews and demonstrates knowledge of National Committee for Quality (NCQA) measures and assists in NCQA evaluation activities related to member rights, responsibilities, and member experience. 9. Supports the Enrollee Advisory Committee, including member recruitment, agenda development, meeting facilitation and reporting; serves as committee secretary and maintains meeting minutes.  10. Supports the Service Advisory Committee (SAC), including agenda development, meeting facilitation, and reporting; serves as SAC secretary and maintains meeting minutes.  11. Facilitates creation of provider newsletters in collaboration with appropriate staff.  12. Facilitates the UPHP policy maintenance process; ensures all policies are up-to-date, available to staff, and retained as required.  13. Coordinates the submission of Michigan Department of Health and Human Services (MDHHS) contract deliverables. 14. Facilitates interdepartmental workgroup to ensure the UPHP website is up-to-date. 15. Performs the day-to-day tasks required to support the Strategic Initiatives Department, which includes, but is not limited to, report drafting/review, document and project management, and government program document maintenance. 16. Enhances professional growth and development through participation in education programs, current literature, in-service meetings, and workshops. 17. Maintains confidentiality of client data. 18. Performs other related duties as assigned or requested.

POSITION QUALIFICATIONS:

Education:

Minimum:

Associate degree in health information processing, business, or health-related field; four (4) years of relevant experience in lieu of a degree will be considered.

 

Preferred:

Bachelor’s degree in business, health education, communications, or other health-related field

 

Experience:

Minimum:

Two (2) to three (3) years of insurance, marketing, or health-related customer service/education(or combination of education and work experience)

 

Preferred:

Three (3) to five (5) years of insurance, marketing, or health-related customer service/education; managed care and/or government programs experience

 

Required Skills:

Keyboarding proficiencyWorking knowledge of MS Office (Word, Excel, and PowerPoint)Excellent human relation and oral/written communication with advanced knowledge of vocabulary, spelling, proper grammar, and punctuationExcellent organizational abilities with attention to detailProofreading, editing, and writing skillsResearch and analytical skillsAbility to operate standard office equipment (photocopier/scanner, fax, etc.) The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing