Individual Member Engagement Representative

4 days ago

Akron, United States Della Infotech, Inc. Full time
Job Description

Performs variety of responsibilities to achieve increased Individual (U65) member retention, including making outreach calls to members. Assists with Individual Marketplace retention and renewals and the explaining of plan benefits. Contacts members with premium delinquency to facilitate timely payments and assists with renewing member contracts during the open enrollment season. Essential Functions: 1. Answers calls from Individual members (on and off Marketplace) during Open Enrollment Period (OEP). Answers renewal, benefit, payment and other questions. Completes data entry into Macess system to document call. 2. Answers billing questions and completes member payments. 3. Makes outbound payment reminders to returning and conditional Individual SummaCare members. 4. Makes welcome calls to new Individual SummaCare members and answers questions to ensure they understand their Individual plan benefits and provider network. Minimum Qualifications: 1. Formal Education Required: High School Diploma or GED is required; Associates or BA/BS preferred. 2. Relevant Experience and Training Includes: A minimum of one (1) year experience in a customer service role preferably in the health insurance / healthcare industry with familiarity with the Individual Marketplace (healthcare.gov) plans offered to those under the age of 65. 3. Required Qualifications a. Completion of SummaCare plan and product and system training prior to open enrollment season. b. Ability to multi-task. Effectively operate computer, learn MACESS system, and utilize SummaCare website and phone system while speaking and collecting information from members. c. Excellent verbal and written communication skills. d. Proficient with Microsoft Office Products. e. Strong understanding of Federal and State regulatory requirements and Marketing Guidelines. f. Able to work independently within team environment. g. Willingness to learn SummaCare Individual products, services and solutions. h. Effective listening and critical thinking skills. i. Ability to develop, prioritize and accomplish goals. j. Demonstrate time management. 4. Level of Physical Demands: Ability to lift up to 20 lbs. Essential Functions: 1. Takes incoming calls from members, make outbound phone calls to members, and document in Macess system. 2. Communicates to Individual SummaCare members accurately to ensure understanding of the product choices available to them during the OEP season. 3. Adheres to all compliance and company rules and mandates set forth in the CMS marketing and compliance guidelines as well as in the company policies and procedures. 4. Services existing members to achieve the highest levels of member retention, profitability and growth. 5. Assists and services members in reviewing plan options to support matching member with most preferred and appropriate plan option. 6. Takes calls from Individual Marketplace members to provide service and facilitate sales and retention. 7. Manages all members within the designated timeframe in order to exceed company standards for quality, accuracy and timeliness. 8. Performs assigned administrative duties as defined by management, including updates and maintenance of appropriate reporting and database systems. Supervisory Responsibilities: None Access to Protected Health Information: Minimal necessary to perform job functions. Complexity: High. Independent judgment, decision-making, problem solving related to technical systems, interpreting policies and procedures to day-to-day operational situations occurring within the department. Stress: High. Variety of work that is complex in nature; requires attention to detail; frequent interruptions and distractions; involves coordinating across departments. Accountable for personal performance and completion of projects across departments. Frequently required to calm and gain confidence of others. Requirements:

Unit Description

Requirements: Employment in this position requires a valid state driver's license, and employment is conditional pending successful clearance of a driver's license record check. Note: This description of duties is not intended to be all-inclusive or to limit the discretionary authority of supervisors to assign additional tasks of a similar nature or level of responsibility.

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