Medicaid Member Relations Representative - JHP

Job Details

Job Description

We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

Perks of JHP and why you will love it here:

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off
• Impact on the communities we service

We are seeking a talented and enthusiastic Member Relations Representative to join our team!

Working under close supervision to promote a positive image of Health Partners via telephone, utilizing each contact as an opportunity to educate callers about the plan and retain members by providing high levels of service. Report on trends and issues impacting the membership, working collaboratively with other departments to assure continued customer satisfaction.

As the Member Relations Representative, your daily duties may include:

• Educate callers about Health Partners' plan with the intent of retaining members.
• Provide high levels of service.
• Report on trends and issues which impact the membership.
• Collaborate with internal departments to facilitate resolutions to member's issues and concerns.
• Respond to member and member-related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service.
• Participate in and conduct new member orientation outreach on a monthly basis as assigned.
• Answer eligibility, benefits and provider inquiries, assuring that members receive service, use the plan correctly and gain a high level of satisfaction with the plan.
• Maintain call records, logs and other documentation in accordance with departmental requirements.
• Operate MIS and telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange.
• Participate in appropriate staff meetings and training sessions, reporting on trends and issues which impact members and Health Partners as a whole.
• Attend monthly meetings.
• Perform other clerical and support tasks as assigned.

Qualifications

• High School Diploma or equivalent.
• 2 years customer service related experience preferred.

Skills, We Value:

• Excellent telephone communication and counseling skills. Bilingual desirable.
• Ability to work independently and as part of a team. Proficient in Departmental Information Systems including DPW, Member Health Information System and Pharmacy System

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.