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Member Support Specialist

2 months ago


San Antonio, Texas, United States TEKsystems Full time

Position Overview:

The primary role of the Member Advocate is to serve as a representative for the Member, facilitating communication between the Health Plan and Providers to guarantee access to necessary healthcare services. This position is vital in fostering community engagement, enhancing Member education, and identifying as well as addressing systemic challenges that may hinder Members' access to suitable care.

Key Responsibilities:

  • Address and manage Member complaints and formal grievances, identifying potential barriers to access and resolving issues in accordance with established grievance protocols.
  • Conduct investigations and resolve issues related to access and cultural sensitivity as highlighted by Member Services staff, state personnel, providers, advocacy organizations, and recipients.
  • Engage with local community organizations to gain insights into the unique healthcare needs of Members, updating and refining educational resources as necessary.
  • Act as the main point of contact for Member advocacy groups, human services agencies, and state entities.
  • Ensure confidentiality is maintained in compliance with HIPAA regulations.

Required Skills and Qualifications:

Essential Skills/Experience:

  • Experience in telephone customer service.
  • Demonstrated reliability and punctuality in the workplace.
  • Preferred Certification: Community Health Worker (CHW) certification.

Desirable Skills/Experience:

  • Proficiency in computer applications such as MS Word and Excel.
  • Bilingual capabilities.
  • Knowledge of Medicaid and Medicare systems.

Experience Level: Expert Level

About TEKsystems:

At TEKsystems, we are committed to driving transformation. We empower clients to activate innovative ideas and solutions, seizing opportunities in a rapidly evolving landscape. Our team, comprising 80,000 professionals, collaborates with over 6,000 clients, including a significant portion of the Fortune 500, across North America, Europe, and Asia. As a leader in Full-Stack Technology Services and Talent Services, we partner with forward-thinking leaders to instigate meaningful change. This is the essence of true collaboration. TEKsystems is part of the Allegis Group family.

TEKsystems is an equal opportunity employer, welcoming applications from all individuals without regard to race, gender, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information, or any characteristic protected by law.