Customer Service Representative

4 days ago

Flint, United States Trice Healthcare Staffing Full time

Below are some key highlights of the position –

Position : Customer Service Representative

Location: Flint, MI

Duration: 3 Months Contract

Shift: Full-Time, Days

Pay Rate: $17/hr.


NOTE: You may have to travel to work in the office 1-2 times a month for training purposes. However, it has been much less than that for the current staff, averaging 1 time every 2-3 months.


Description:

Responsible for delivering, strategizing, and improving quality with a focus on primary care. The position will educate and network with people of diverse backgrounds and cultures on products and programs to attract and retain membership in the Plan.. Establishes and maintains relationships for the promotion of healthy lifestyles among membership. Tracks and trends HEDIS rates. Responsible for member and provider contacts and positive outcomes. Foster the Plan’s presence in the community by interacting with members, providers, and outside agencies as assigned.

Essential Functions and Responsibilities:

1. Ensures members awareness of and access to primary care services through education and coordination of members and providers resulting in HEDIS improvement.

2. Engages with assigned Provider offices on HEDIS gaps in care, work collaboratively with the provider office to review records, close gaps in care in supplemental databases, and schedule patient appointments upon request.

3. Performs annual HEDIS Hybrid audit activities, including scheduling appointments with the office, reviewing records through provider office EMR or onsite as required.

4. Participates in the development and delivery of Outreach Programs, including call programs and member contacts which result in key HEDIS measures attainment.

5. Establishes and maintains relationships with the primary care network, community programs, providers and members.

6. Coordinates quality improvement initiatives with Medical Management Dept., i.e., Preventative Health Screenings.

7. Communicates updated active community resource information to medical management and individual members as needed.

8. Responsible for presentations and seminars for health lifestyles as needed.

9. Participates in Departmental Projects, as appropriate.

10. Other duties as assigned or when necessary to maintain efficient operations of the department and the Company as a whole.

Requirements:

  • High School Diploma - Required,
  • 2+ years of Experience in a customer service related role - Required
  • Must have valid state Drivers license, reliable transportation, and auto insurance - Please include in profile
  • This position is hybrid - Required

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