Description
AS34960-Customer Engagement Resource Specialist
Rockville, MD 20852
Position type: w2
Contact duration: 11 months + (strong possibility of extension)
POSITION TITLE:
Customer Engagement Resource Specialist (Formerly Member Assistance & Resource Specialist)
Purpose:
To assist members and staff in dealing with and resolving a wide variety of issues to ensure the highest possible member satisfaction based on customer centric interventions.
This position consistently supports compliance and the Principles of Responsibility (Client's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Client's policies and procedures. In addition, Regional leaders are accountable for communication, implementation, enforcement, monitoring and oversight of compliance policies and practices in their departments.
In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Client's Service Quality Credo, the client Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.
Accountabilities:
1. Serves as the primary resource expert for information about products, benefits, and policies, as well as how these plans and policies are operationalized and administered.
2. Assists members, employers groups, brokers, and other staff in resolving problems, including clarification of benefits, appointment access, medical referrals, payment of claims, and concerns about quality of care and service to ensure that service standards are met in compliance with applicable state and federal regulations.
3. Documents encounters, tracks issues, generates monthly reports, and conducts trend analyses, and develop recommendations for service improvements.
4. Coordinates health plan, community-based, and out-of-area services for members as needed, and serves as the member advocate to assure prompt delivery of health care.
5. Facilitates resolution of member claims, including orienting members, communication with appropriate claims and external providers.
6. Tracks status of pending complaints and follows-up as needed to expedite completion of the claim.
7. Conducts member, employer groups, brokers, staff, or provider orientations to ensure familiarity with Client's services, systems, processes, and procedures. Trains and educates staff in dealing effectively with members and difficult situations to enable continuous improvement in customer service. Informs staff of current changes in the benefit programs
8. Participates in member outreach and on-boarding projects as needed.
9. Identifies and communicates members', employer groups, or brokers needs and expectations to other departments to ensure high quality customer experiences
10. Duties as assigned.
Two or three years of customer service experience in a healthcare environment are required.
1. Experience with medical claims systems is preferred.
2. Demonstrated expertise in dealing with difficult situations is required.
3. Effective written and oral communication skills are required.
4. Demonstrated competence with Windows-based word processing software is required.
Minimum Requirement - Education and/or Classes:
1. Bachelor's Degree is preferred.
2. Coursework in behavioral sciences is preferred.
3. Familiarity with medical terminology is required.