Member Support Representative
Location: Cambridge Massachusetts
Description: Senior Whole Health is in need of Member Support Representative right now, this vacancy will be placed in Massachusetts. For complete informations about this vacancy opportunity please give attention to these descriptions. The Member Support Representative (MSR) works telephonically with members, SWH Nurse Care Managers, providers and community service organizations to ensure that m! embers have accurate information about the Plan, Plan benefits, and services. The MSR Call Center provides the first level of contact for members and providers on the Client Services ACD line and provides accurate benefit information for members, designated caregivers, and providers. The MSR addresses member, caregiver and provider inquiries and complaints, and attempts to resolve them as quickly as possible. The MSR Call Center provides arranges transportation and other services as defined in their responsibilities.
SENIOR WHOLE HEALTH (SWH) is a rapidly growing Medicare Advantage Special Needs Plan, pioneering the way health care is provided to low-income seniors. Our mission is to maximize the quality of life, health and independence for our Members.
Essential Functions/Responsibilities:
Manage and respond to member and provider phone calls from the ACD line accurately and professionally.
Collaborate with SWH care management staff to! address and resolve the needs and concerns of members, caregi! vers and providers and other departments (Claims, Enrollment, etc.)
Conduct outbound enrollment verification (OEV) calls with all new enrolees using CMS approved script.
Conduct telephonic triage assessments with new enrolees and identify triggers for referrals and follow up with SWH Nurse Care Manager and/or GSSC; to be combined with OEV call where appropriate to demonstrate continuity of care.
Conduct welcome and follow up calls with members as directed.
Provide timely and accurate information regarding member benefits and services.
Input data and record all contacts and actions in the Centralized Enrolment Record (CER)
Assist CS staff with scheduling of member appointments, transportation, translation, and interpretation services.
Assist with responding to triaged alerts, as assigned by call center supervisor, of member inquiries and complaints, transportation requests and other referrals to community based p! rograms as needed.
Assist with member mailings and respond to questions about mailings.
Assist with timely resolution of problems or complaints by members or providers.
Conduct post-discharge calls to members upon care transition from SNF, hospital, LTC.
Enter authorizations and extensions for home based community services (HBCS).
Other duties and responsibilities as assigned.
Qualifications:
Extensive knowledge and experience with community organizations, social services, and public resources.
Ability to problem solve with providers, members, caregivers and colleagues to address member needs and concerns.
High school diploma and/or Associates degree.
Minimum of two years of related work experience preferred.
Health care /customer service experience preferred.
Knowledge of elder and disabled services a plus.
Good computer skills.
Minimum of two yea! rs experience working in customer service, health or social service set! ting.
Strong computing knowledge and skills.
Bilingual ability required, Spanish, or Toishanese, Vietnamese, is highly Preferred.
Full time and per diem positions available.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Senior Whole Health.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Wed, 06 Nov 2013 21:53:52 GMT