UM Member Liaison
3 weeks ago
Summary
The UM Member Liaison acts as an advocate on behalf of the member to address any concerns or questions they may have regarding their medical care relationship(s) with providers. The Liaison also works closely with the health plans with member assignment and access to care. The UM Member Liaison reports directly to the Outpatient UM Manager.
Duties and Responsibilities
· Assist members on realigning to a new Health Plan or Primary Care Physician (PCP)
· Notify Health Plan or state entity when members are outside of the county area or move out of state
· Educates members and their families re: managed care process and Health Plan Options/Programs
· Verifies health insurance coverage for members
· Facilitates communication between members and their physicians
· Submit request to health plan to realign member when PCP requests dissolution from member permanently
· Collaborates with Provider Network Operations team on provider and member disputes
· Assists in special projects, as needed
Minimum Job Requirements
· Minimum 1-year experience in managed care or medical field
· Knowledge of medical terminology
· Fluency in both English and Spanish
· Proficiency Microsoft Office, especially Excel and Word
· Knowledge of EZ-CAP a plus
Skill and Abilities
· Strong verbal and written communication skills
· Ability to empathize with complex cases
· Strong customer service skills with good telephone rapport
· Ability to multi-task while remaining adaptable and flexible to fast-paced environment
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