Member Liaison Specialist

2 weeks ago

Orange, United States CalOptima Full time

**Member Liaison Specialist (Customer Service) (Bilingual)**

**CalOptima**

**CalOptima Health** is seeking a highly motivated an experienced **Member Liaison Specialist** to join our team. The Member Liaison Specialist (Customer Service) will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program. The incumbent will serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues.

**Position Information**:

- Department**:Member Liaison Program**:

- Salary Grade**:302 - $49,754 - $69,655 ($23.92 - $33.4880)**:

- Work Arrangement**:Full Office**

**Duties & Responsibilities**:

- 85% - Member Support
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short
- and long-term goals/priorities for the department.
- Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.
- Intakes information from members, both over the phone and/or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.
- Coordinates members' health care and social service needs both within and outside the health network and CalOptima Health during the original interaction.
- Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals/authorizations for medical care related to services covered under the Whole-Child Model program.
- Guides members in understanding and accessing the benefits under the Whole-Child Model program.
- Maintains documentation of member cases within the FACETS system.
- Initiates referrals to internal and external care management departments and government agencies. Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes and helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services.
- 10% - Administrative Support
- Collaborates with interdepartmental staff in call resolution as needed.
- Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines. Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health.- 5% - Completes other projects and duties as assigned.

**Minimum Qualifications**:

- High School diploma or equivalent required.
- 2 years of experience as a call center agent or customer/member services representative in health care required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) required.

**Preferred Qualifications**:

- 2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity.
- Health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience.

**Required Licensure / Certifications**:

- N/A

**Knowledge & Abilities**:

- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.

**Physical Requirements (With or Without Accommodations)**:

- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, p

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