Description:
GENERAL SUMMARY
Coordinates member outreach to ensure effective use of health plan benefits and to improve member health outcomes within the Medicaid or Medicare population. Responds to member inquiries in person, via telephone, and in writing.
ESSENTIAL RESPONSIBILITIES
- Identifies potential resources and initiates collaboration with community centers, mental health centers, faith/ethnic-based social service organizations, and school organizations to improve member health outcomes and Healthcare Effectiveness Data and Information Set (HEDIS) measures.
- Makes outbound calls to members to provide assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes. Identifies when to refer member to Social Worker or Case Manager.
- Investigates and responds to member inquiries regarding benefits in person, via telephone, and in writing.
- Distributes educational information to members by most appropriate method (mailings, social media, automated calls, etc.) to help them utilize benefits more effectively.
- Develops educational/outreach materials including but not limited to incentive documents, call scripts, event flyers, social media text, etc.
- May develop and maintain member incentive programs to support HEDIS initiatives. Maintains incentive database to track member compliance.
- May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events) to heighten awareness of Coventry’s name. Works with internal staff to schedule, organize, and staff these events.
- May document complaints and grievances from members and refer them to the appropriate department for timely resolution.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent. Bachelor’s degree preferred.
- Previous (3-5 years) outreach experience working with the Medicaid or Medicare population required.
- Previous customer service experience in a call center environment preferred.
- Demonstrated written and verbal communication skills.
- Ability to work independently.
- Ability to use standard corporate software packages and corporate applications.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Richmond, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-04-15 00:00:00.0
Job ID: 1311389
GENERAL SUMMARY
Coordinates member outreach to ensure effective use of health plan benefits and to improve member health outcomes within the Medicaid or Medicare population. Responds to member inquiries in person, via telephone, and in writing.
ESSENTIAL RESPONSIBILITIES
- Identifies potential resources and initiates collaboration with community centers, mental health centers, faith/ethnic-based social service organizations, and school organizations to improve member health outcomes and Healthcare Effectiveness Data and Information Set (HEDIS) measures.
- Makes outbound calls to members to provide assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes. Identifies when to refer member to Social Worker or Case Manager.
- Investigates and responds to member inquiries regarding benefits in person, via telephone, and in writing.
- Distributes educational information to members by most appropriate method (mailings, social media, automated calls, etc.) to help them utilize benefits more effectively.
- Develops educational/outreach materials including but not limited to incentive documents, call scripts, event flyers, social media text, etc.
- May develop and maintain member incentive programs to support HEDIS initiatives. Maintains incentive database to track member compliance.
- May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events) to heighten awareness of Coventry’s name. Works with internal staff to schedule, organize, and staff these events.
- May document complaints and grievances from members and refer them to the appropriate department for timely resolution.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- High school degree or equivalent. Bachelor’s degree preferred.
- Previous (3-5 years) outreach experience working with the Medicaid or Medicare population required.
- Previous customer service experience in a call center environment preferred.
- Demonstrated written and verbal communication skills.
- Ability to work independently.
- Ability to use standard corporate software packages and corporate applications.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Richmond, KY, US
Other Locations: ,
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2013-04-15 00:00:00.0
Job ID: 1311389