Job Summary

We are looking for a detailed professional to add to our team as Healthcare Concierge. The Concierge should have relevant customer service experience, preferably with Medicare experience and specifically with Medicare Advantage programs, and familiar with PPO’s and HMO’s. Must have strong oral and written communication skills, planning and problem-solving skills, and be skilled in personal diplomacy. The applicant must possess a high level of motivation, professionalism, and ethical conduct and place a premium on treating others with dignity and respect.

Major Work Activities

• Receive all inbound calls from the member population and conduct proactive outbound calls as assigned
• Address member concerns and answer questions related to claims issues, provider resources, benefits, and member enrollment/disenrollment and service issues
• Resolution and timely response to all member problems within expected or required timeframes
• Management of the customer relationship to ensure retention and maintain member loyalty
• Provide member education and counseling on access to services, benefits, and providers
• Assume ownership and responsibility for member satisfaction with HealthTeam Advantage
• Perform verification calls for members that have enrolled in the HealthTeam Advantage plan as well as perform welcome calls to those members that do not require a verification call
• Assist in grievance and appeals process
• Ability to work before/past normal shift hours to complete any outstanding tasks for a member(s). May have to work mandatory overtime during certain timeframes in the calendar year (i.e.: AEP, Quality Measure initiatives other special projects)
• Maintain personal metrics to established performance levels of the team
• Ability to work either the 8:00 AM-5:00 PM, 8:30 AM-5:30 PM or 11:00 AM-8:00 PM Monday through Friday outside of Annual Enrollment Period and ability to be flexible with time during the Annual Enrollment Period when healthcare Concierge service hours are 8:00 AM-8:00 PM Seven days a week

Minimum Qualifications

Required Education

High School diploma, GED, or equivalent work experience

Required Experience

• Customer service, sales, or account management experience
• Call Center/ High call volume handling experience
• Managed care or health plan operations experience
• Medicare experience preferable
• Thorough knowledge of CMS guidelines, process, and systems

Required Knowledge, Skills, and Abilities

Thorough knowledge of CMS guidelines, process, and systems

• Excellent problem solving and organizational skills
• Strong interpersonal communication skills
• Excellent knowledge of Microsoft Office (Excel, Word, PowerPoint)
• Ability to work independently or as a team
• Operate general office equipment, including but not limited to computers, phones, and related devices.