Member Support Specialist

Job not on LinkedIn

🔥 1 minute ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $35.5k - $56.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💝 Customer Support

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 that create barriers to medical-regimen adherence and optimal 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 structures • 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 • Collaborate with the case-management team and participate in case-management/care-coordination meetings • Maintain compliance with state and federal regulations, HIPAA standards, confidentiality, and accurate 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 • Support care management quality measures required by government regulations • Enter and collate data and prepare assigned reports • Participate in requested committees • Make small-group presentations • Participate in quality-improvement initiatives • 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 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/filing motions, and lightly lift and carry files and business materials • Ability to travel approximately 20% of the time

🏖️ Benefits

• Equal opportunity employment • Work-from-home arrangement in North Carolina • Travel required approximately 20% of the time • Ergonomically configured equipment • Participation in quality improvement initiatives • Participation in team, department, company, and community-related committees • At-will employment