Member Enrollment Liaison Jobs

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Meeting and exceeding State and Federal regulatory requirements for quality, compliance, and turnaround times.

Hires and coordinates training, and manages staff involved in creating controls, documents, and tools within the Member Core Ops Team.

Design and implement systematic approach to improve member experiences through increased operational efficiency and effectiveness.

Responsible for reporting potential liabilities for financial tracking and accruals to senior leadership.

Excellent verbal and written communication skills.

Complete all necessary continued learning and training requirements per department and company need

1 to 2 years of Call Center experience in a fast-paced setting

Computer navigation skills, including multiple screens, simultaneous systems use, phone and CRM systems

Excellent verbal and written communication skills for both note-taking and call purposes

Experience with Salesforce or other CRM software

Eligible for benefits within 30 days

Data & Reporting: Manage key reports and track relevant data to identify successes and drive refinements in operational processes.

Must be detail oriented and present critical analytical thinking skills with exceptional communication skills and focus on customer centricity.

Comfortable and competent with using common administrative technologies (e.g. Zoom, Slack, Office or equivalent), experience delivering on telehealth platforms preferred.

Well organized, ability to manage multiple projects at once, eye for details, and collaborate within and across teams

Virtual-first culture: Work from home anywhere in the US

Technical Support: Assess for and address any technical difficulties that could be preventing member enrollment.

Access to a remote work environment with offices in Los Angeles and New York City

Build rapport with prospective members and effectively convey the benefits of the Hiring Company program

This is a remote position within the United States

Excellent interpersonal skills and ability to quickly build rapport over the phone

Capable of overcoming objections and effectively conveying benefits to potential members

Strong organizational skills and ability to make a high volume of outbound calls

Follows guidelines in alignment with all health plan requirements as related to the provider certification and credentialing.

Must be able to function independently, possess demonstrated flexibility in multiple project management

Works with care centers to obtain updates to licenses, certifications, and certificates of insurance and ensures timely renewal for the same.

2+ years healthcare experience working with providers and care center staff

Demonstrated skills in problem solving and analysis and resolution

High level of attention to detail with exceptional organizational skills

Utilize multiple systems to investigate escalated inquiries on Members and follow the member experience from beginning to resolution

Manage resolution of activities in CRM, including HICS from CMS according to defined turnaround times

Collaborate with internal teams and external partners to resolve complaints and document issue and resolution in CRM

Conduct member outreach based on a variety of trends such as frequent caller data and out of network claim denials

Recommend workflows and policy as a result of Member feedback and escalation data analysis

Document appropriate client specific information in CRM

Complete all necessary continued learning and training requirements per department and company need

1 to 2 years Call Center experience in fast-paced setting

Excellent written and communication skills

Experience with Salesforce or other CRM software

Shift start times range from 10:00a - 11:30am Est Monday- Friday [Excepting applicants in EST, CST, MST time zone]

Equipment and hardware provided. Interviewing, orientation, and training are conducted virtually.

Utilization Management, Case Management, Care Coordination, or Telephonic Case Management experience a plus

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

Collaborate and communicate with management on issues and processes that impact Care Management and other organizational entities internally and externally.

Maintain documentation of member interactions within the Member Services Management System (HealthSuite/Qualitysuite).

Initiates referrals to both internal care management departments and other government agencies.

Using critical thinking and problem-solving skills, quickly resolve issues and identify resources to ensure a positive client experience and complete satisfaction