Customer Service Rep

Job Responsibilities:

• Initiate outreach efforts, face-to-face, related to targeted preventive health, maternity, care transitions and chronic condition initiatives.
• Educate member(s) on the importance of targeted preventive health services, assess opportunity for care management intervention and make appropriate referrals, including referrals to the Behavioral Health Managed Care Organization (BHMCO) as needed. Contact member(s), providers, and community agencies to coordinate access to preventive health services.
• Develop a rapport with members and community centers to establish a supportive relationship which empowers members to take an active role in their health and wellness.
• Assist members with completing a Health Risk Assessment, identifies/providing direction to managing healthcare barriers (i.e., knowledge deficit, transportation, financial), scheduling appointments, and answering questions.
• Collaborate with human services providers such as Head Start Programs, WIC, community centers, and homeless shelters; as well as state agencies such as Children and Youth Services (CYS) and juvenile probation in the identification and outreach to members in need of services.
• Understand the Organization's lines of business and benefits for members to provide accurate and current information to member in the community.
• Contribute to the development and preparation of educational materials for members and providers.
• Conduct provider and community training on Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services and other special preventive health initiatives.
• Provide summary and outcomes of training to management and peers.
• Participate in the development of programs that are effective, measurable, and innovative, with a special emphasis on reaching at risk members.
• Represent the company at community events, including events sponsored by community centers.

Skills:

• High School Diploma/GED
• Act 33/34 and 73 clearances required (does not need to have at time of submittal; if offered position, must obtain clearances prior to starting assignment)
• Knowledge of principles and processes for providing customer service.
• This includes customer needs assessment, meeting quality standards for services.
• The ability to interact well with peers, supervisors and customers and work as a team member
• Ability to solve problems independently and creatively and be proactive, self-directed, assertive, and creative in problem solving and system planning.
• Ability to handle many tasks simultaneously and respond to customers and their issues promptly
• Possess good written and oral communication skills
• Have an appreciation of cultural diversity and sensitivity towards the Medicaid population with demonstrated expertise in topics related to cultural competency including working with members with limited English proficiency.
• Be aware of issues members face related to healthcare including transportation, childcare, lack of knowledge concerning preventive health, distrust of the system as well as other personal, social, financial barriers
• Must demonstrate patience and empathy when interacting with members and all internal/external customers
• Must have medical assistant experience
• Must have call center experience.

Education/Experience:

• Experience in a health care related customer service or marketing environment that would demonstrate the ability to positively impact the engagement of members in the organization's condition and case management programs
• Bilingual, Spanish speaking
• Basic medical terminology background
• Experience with the targeted community or population