Member Support Specialist II

Job not on LinkedIn

🔥 14 minutes ago

🍑 Georgia – Remote

🍑 Georgia – Remote

💵 $35.5k - $56.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💝 Customer Support

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Develop and implement goals and plans with case managers to help members navigate the healthcare system • Educate members on understanding and working within their benefit structure • Use motivational interviewing and patient-engagement techniques to support optimal health outcomes • Identify community resources and make appropriate referrals • Serve as liaison between members and providers/agencies • Identify members for coordination and case management services using claims data and reports • Screen requests for appropriate case management referrals from internal and external sources • Collaborate with the case management team and participate in case management/care coordination meetings • Ensure compliance with state and federal regulations, HIPAA standards, and confidentiality requirements • Maintain accurate and timely documentation • Assist with referrals, appointment scheduling, and transportation to medical appointments • Assist members with non-clinical needs during transitions and phases of care • Manage mailing lists and outgoing mailings • Assist with departmental procedures, reports, and projects • Assist care management in meeting government-regulated quality measures • Enter and collate data and prepare assigned reports • Participate in committees and make small-group presentations • Perform other duties as assigned

🎯 Requirements

• Minimum of three years of experience in community services or healthcare agencies focused on coordination services • Experience in health insurance and delivering group presentations preferred • High school diploma or equivalent required • Knowledge of medical terminology • Proficient in Microsoft Office, including Word, Excel, and PowerPoint • Experience with medical management software, such as CaseTrakker Dynamo • Excellent verbal and written communication skills • Ability to work independently and effectively on a team • Good working knowledge of how to access community resources and the healthcare system • Ability to meet department and company performance and attendance expectations • Ability to stoop and bend • Ability to sit and/or stand for extended periods • Ability to perform repetitive typing, sorting, and filing • Ability to lightly lift and carry files and business materials • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Approximately 20% travel required

🏖️ Benefits

• Telephonic and in-person member support • Work inside in a general office setting with ergonomically configured equipment • Equal opportunity employment • Participation in quality improvement initiatives • Participation in team, department, company, and community-related committees

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