Member Support Specialist II

Job not on LinkedIn

🔥 12 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

• Serve as a resource to members with complex psychosocial issues affecting medical-regimen adherence and health outcomes • Work telephonically and in person to support members • Coordinate with case managers to develop and implement member-specific goals and plans • Educate members about their benefit structure • Use motivational interviewing and patient-engagement techniques • Identify community resources and make 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 • Collaborate with the case-management team and participate in care-coordination meetings • Maintain compliance with state and federal regulations, HIPAA, and confidentiality requirements • Maintain accurate and timely documentation • Assist with referrals, appointment scheduling, and transportation to medical appointments • Support members with non-clinical needs during transitions and phases of care • Manage mailing lists and outgoing mailings • Assist with departmental procedures, reports, projects, and quality measures • Enter and collate data and prepare reports • Participate in committees and make small-group presentations • Meet department and company performance and attendance expectations • 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 • Proficiency 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 accessing community resources and the healthcare system • Ability to read and comprehend written and spoken English • Ability to communicate clearly and effectively • Ability to stoop and bend, sit and/or stand for extended periods, perform repetitive typing, sorting and filing, and lift and carry files and business materials • Travel approximately 20% of the time

🏖️ Benefits

• Equal opportunity employment • Work-from-home arrangement • Ergonomically configured equipment • Participation in quality improvement initiatives • Participation in team, department, company, and community-related committees • At-will employment

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