Member Services Representative

Description Job Title: Member Education and Outreach SpecialistTrain onsite for 30-60 days then work remote from homeResponsibilities: As a Member Education and Outreach Specialist, your role is crucial in providing comprehensive member education and outreach services.Key responsibilities include, but are not limited to:General Health Education:Deliver health education on key objectives, focusing on childhood, adolescent, and adult development skills and needs.Provide information on chronic disease prevention and educate members on specific HEDIS measures.Emphasize the importance of scheduling appointments for necessary services.Outbound Educational Calls:Conduct outbound educational telephone calls to inform members about available benefits, services, and programs.Complete health needs assessments and refer members to Population Health Programs as required.Appointment Coordination:Encourage and motivate members to become compliant by scheduling appointments.Coordinate needed appointments with provider offices, ensuring seamless access to services.Provider Knowledge:Maintain familiarity with provider locations and specialties to enhance member access to services.Transportation Coordination:Coordinate transportation to and from appointments when necessary, ensuring members can access essential services.Customer Interaction:Treat customers with a courteous, friendly tone and maintain a professional demeanor.Listen attentively to customer needs and concerns.Compliance and System Utilization:Stay informed about HEDIS measures, claims billing guidelines, and health plan standards.Utilize member engagement techniques and offer incentives as applicable.Use systems such as Facets, CareCommunications Management Systems (CCMS), and Care Advance (CA) for efficient operations.Call Queue Management:Manage CCMS call queue daily to ensure timely completion of tasks, especially for specific call types (e.g., prenatal, postpartum, immunizations, appointment reminders, and follow-ups).Community Resource Education:Educate members on available community resources as necessary to enhance their overall well-being.Flexible Support:Assist with inbound customer service lines and be willing to work overtime as needed to meet member needs.This role is essential in fostering a proactive and supportive approach to member health education and engagement, contributing to the overall well-being of our community.Requirements Health Insurance, Health education, Wellness Plans, Wellness Programs, Centers for Medicare & Medicaid Services (CMS), EMR - Electronic Medical Records, HIPAA Compliance - Patient Privacy Rule, Medicaid, Medicare Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https:///www.roberthalf.com/us/en/terms) .