Member Services Outreach Specialist

4 weeks ago

Bakersfield, United States KHS Full time

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the full time position of Member Services Outreach Specialist in the range of $19.00 - $21.02 hourly.

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Definition

Under the direction of the Department Supervisor, the Member Services Outreach Specialist will perform outreach calls, answer incoming calls, and respond to inquiries regarding Plan benefits and facilitate appropriate resolutions including clerical and data entry functions as needed.

Distinguishing Characteristics

The incumbent will have daily and extensive contact with members and providers over the phone and in person to assist and resolve issues, explain benefits, and respond to requests for services including a variety of clerical functions for a Knox-Keene licensed maintenance organization (HMO).

Essential Functions

  • Answer incoming calls and document all interactions with callers by appropriately coding and logging in CRM.
  • Make outgoing calls and document all interactions with callers by appropriately coding and logging in CRM.
  • Assist members, providers or other KHS Departments with scheduling medical appointments and assisting with scheduling transportation needs for members.
  • Work directly with members and providers to identify and resolve health care service concerns.
  • Employs effective communication methods to promote positive and productive public relations with members, providers and other KHS departments.
  • Identifies, investigates, resolves, and reports member/provider issues to management.
  • Prepares reports and submits results through the established administrative channels.
  • Composes simple letters, memos, confidential reports, and completes standard forms from information received in handwritten or typed form, generally without being given specific oral or written instructions.
  • Answer phones in a specified time frame, while maintaining a high quality of customer service for members and providers.
  • Responsible for assisting the Member Services Trainer with training new Member Services Outreach Specialists as they are hired.
  • Operates a variety of office machines such as, copier, facsimile, and multiple line telephone systems.
Other Functions
  • Assists management staff and other departments in completing special projects, as assigned.
  • Performs other job-related duties as required.
  • Adheres to all company policies and procedures relative to employment and job responsibilities.
Employment Standards

Education: High School Diploma from an accredited school or equivalent.

Experience: One (1) or more years of recent experience in a customer service organization or related field preferably in the managed care and /or health insurance industry.

Typing skills of 30 NWPM (certificate required).

Knowledge of: Excellent customer service and telephone techniques and etiquette. Health Maintenance Organizations (HMO) desirable.

Ability to: Work under pressure; work independently and manage multi-task responsibilities; be willing and able to assist and educate the member; intervene effectively in a crisis situation on behalf of an upset, distraught, dissatisfied, confused or angry member; organize and set priorities; adhere to state and federal timelines; have excellent communication skills both written and verbal and work in a rapidly evolving work environment.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.

Other details
  • Pay Type Hourly
  • Min Hiring Rate $19.00
  • Max Hiring Rate $21.02
  • Telecommute % 0
  • Required Education High School


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