Job Details

The Member Relations Representative (Tier 1) promotes a positive image of Health Partners Plans (HPP) via telephone, utilizing each contact as an opportunity to educate members and providers about the plan, effectively handling inbound, outbound and outreach calls to and from members, providers and other areas internal and external to HPP. This role requires a basic understanding of the concepts of Medicaid, Medicare and CHIP lines of business and demonstrating skills in assisting the members/providers with the reason for the call as outlined in the primary responsibilities or escalating the call as appropriate to the Tier II level of agents. Ensure member retention as well as advise them of specific eligibility requirements to assure continued customer satisfaction.

Job Description

Primary Responsibilities:

Educate members and providers about Health Partners’ plan with the intent of retaining members and providing a high level of customer service.
Respond to member and member-related calls in a courteous, professional & efficient manner providing timely follow-up to requests for information and service.
Answer eligibility and benefits questions, assuring that members receive service, use the plan correctly and gain a high level of satisfaction with the plan.
Assist members with demographic changes, updates or as required coordinating the changes with the County Assistance Office, CMS, Office of CHIP or the Department of Health and Human Services.
Assist members and providers with registering on the member/provider portal and basic self service functions.
Assist with requests for ID cards, Welcome Kits, member handbook, provider directory or any other printed material that can be mailed out.
Assist with PCP changes and scheduling initial doctor appointments
Collaborate or escalate with internal departments to facilitate resolutions to member’s issues and concerns.
Conduct targeted telephonic outreach to members using a prepared script depending on Manager’s direction.
Open or build new cases in the care management system and route to the appropriate staff following the direction of the Team Leader, Supervisor or Manager.
Research members’ demographics in regulatory system and build cases in Member Relations documentation system by calling hospitals, PCP offices, and/or home care agencies to locate a member’s most recent phone number.
Schedule and coordinate transportation needs.
Utilize the Member Relations translation vendor as indicated by the needs of the member.
Refer members to the appropriate Nurse Advice lines and appropriate programs.
Maintain accurate data entry into designated software systems.
Promote partnership with Quality Management (QM), Utilization Management (UM), Care Coordination, Healthcare Economics and Special Needs Unit (SNU).
Maintain call records, logs and other documentation in accordance with departmental requirements.
Escalate trends and issues which impact the membership for immediate resolution.
Operate all applications 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 as scheduled.
Adhere to daily schedule, responding to emails timely, use of appropriate call center status, confidentiality of information, and general business protocols.
Perform other clerical and support tasks as assigned.
Other duties as assigned.

Work Environment:

This job operates in a remote setting. HPP allows employees to work remotely based on its determination that a remote work arrangement is appropriate based on HPP’s business needs and the employee’s ability to perform the job remotely in an effective manner. Should those business needs change, HPP reserves the right to change the remote working arrangement at any time, in accordance with HPP’s Flexible Remote-Working Policy. HPP will provide a minimum notice of 60 days of any change in the remote working arrangement,

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

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.

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