Member Relations Rep - JHP

Job Details

We are currently hiring for Member Relations Representatives for our next training class. Candidates must be available to start and train during these dates in order to be considered.

Hire Date 10/6, *Training 10/13-11/3

Job Description

The Member Relations Representative (Tier 1) promotes a positive image of Health Partners Plans (HPP) via telephone, utilizing each contact as an opportunity to educate members and providers about the plan, effectively handling inbound, outbound and outreach calls to and from members, providers and other areas internal and external to HPP. This role requires a basic understanding of the concepts of Medicaid, Medicare and CHIP lines of business and demonstrating skills in assisting the members/providers with the reason for the call as outlined in the primary responsibilities or escalating the call as appropriate to the Tier II level of agents. Ensure member retention as well as advise them of specific eligibility requirements to assure continued customer satisfaction.

Primary Responsibilities:

• Educate members and providers about Health Partners’ plan with the intent of retaining members and providing a high level of customer service.
• Respond to member and member-related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service.
• Answer eligibility and benefits questions, assuring that members receive service, use the plan correctly and gain a high level of satisfaction with the plan.
• Assist members with demographic changes, updates or as required coordinating the changes with the County Assistance Office, CMS, Office of CHIP or the Department of  Health and Human Services.
• Assist members and providers with registering on the member/provider portal and basic self service functions.
• Assist with requests for ID cards, Welcome Kits, member handbook, provider directory or any other printed material that can be mailed out.
• Assist with PCP changes and scheduling initial doctor appointments
• Collaborate or escalate with internal departments to facilitate resolutions to member’s issues and concerns.
• Conduct targeted telephonic outreach to members using a prepared script depending on Manager’s direction.
• Open or build new cases in the care management system and route to the appropriate staff following the direction of the Team Leader, Supervisor or Manager.
• Research members’ demographics in regulatory system and build cases in Member Relations documentation system by calling hospitals, PCP offices, and/or home care agencies to locate a member’s most recent phone number.
• Schedule and coordinate transportation needs.
• Utilize the Member Relations translation vendor as indicated by the needs of the member.
• Refer members to the appropriate Nurse Advice lines and appropriate programs.
• Maintain accurate data entry into designated software systems.
• Promote partnership with Quality Management (QM), Utilization Management (UM), Care Coordination, Healthcare Economics and Special Needs Unit (SNU).
•  Maintain call records, logs and other documentation in accordance with departmental requirements.
• Escalate trends and issues which impact the membership for immediate resolution.
• Operate all applications and telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange. 
• Participate in appropriate staff meetings and training sessions, reporting on trends and issues which impact members and Health Partners as a whole.
• Attend monthly meetings as scheduled.
• Adhere to daily schedule, responding to emails timely, use of appropriate call center status, confidentiality of information, and general business protocols.
• Perform other clerical and support tasks as assigned. 
• Other duties as assigned.

Work Environment:

This job operates in a remote setting. HPP allows employees to work remotely based on its determination that a remote work arrangement is appropriate based on HPP’s business needs and the employee’s ability to perform the job remotely in an effective manner.  Should those business needs change, HPP reserves the right to change the remote working arrangement at any time, in accordance with HPP’s Flexible Remote-Working Policy. HPP will provide a minimum notice of 60 days of any change in the remote working arrangement,

Physical Demands

While performing the duties of this job, the employee is regularly required to talk and hear and document.

Travel

0% of work week, unless otherwise required for business needs.

Work Location

This position is available to work from home; in accordance with our Flexible