This position is forEasy Choice Health Plan Inc.in Cypress, CA, a WellCare Healthplans, Inc. company.
Contacts post-enrollment beneficiaries for retention support and conducts sales agent compliance audits.
Department: CA- State Operations
Reports to: Sr Mgr, State Operations
Location: 10803 Hope Street Suite B, Cypress, CA 90630
Job Type: Hourly/Non-exempt
- Makes outbound calls to newly enrolled members (30 days, 60 days, & 90 days after enrollment is initiated) to discuss the HMO process, assist with scheduling appointments, answer benefit questions, & assist with preventative care education to increase HEDIS and STARS.
- Makes outbound calls to disenrolled members to survey member's dissatisfactions and identify process improvement opportunities. Follows compliance guidelines and provide feedback to help identify areas of improvement.
- Inputs retention and compliance tracking into a database for the purpose of tracking, trending, & reporting.
- Performs member outreach to assist Health Services in closing care gaps.
- Participates in the Member Navigation program which provides members with personal health care representatives that assist them in navigating through the managed care process.
- Assists Network Management in obtaining patient charts for the purposes of increasing RAPS scores.
- Identifies opportunities to improve the process for outbound calls, member contact and surveys.
- Performs other duties as assigned.
- Required A High School or GED
- Preferred An Associate's Degree in a related field
- Required 2 years of experience in outbound sales or customer service
- Intermediate Demonstrated customer service skills
- Beginner Ability to effectively present information and respond to questions from families, members, and providers
- Beginner Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
- Beginner Ability to work independently
- Intermediate Demonstrated interpersonal/verbal communication skills
- Beginner Demonstrated problem solving skills
- Beginner Demonstrated time management and priority setting skills
- Beginner Knowledge of healthcare delivery
- Required Beginner Microsoft Outlook
- Required Beginner Microsoft Word
- Required Beginner Other Ability to learn and use reporting tools (Crystal, Discovery, etc.)
- Preferred Beginner Microsoft Excel