The Healthcare Concierge should have relevant customer service experience, preferably with Medicare, specifically Medicare Advantage programs, and be familiar with PPOs and HMOs. 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.  

ESSENTIAL DUTIES AND RESPONSIBILITIES 

• 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, billing, member enrollment/disenrollment and service issues
• Resolution and timely response to all member problems within expected or required timeframes
• Adhere to set Member Services call center metrics and call evaluation requirements, including, but not limited to, set monthly call volume, call quality scores, abandonment rates, CMS service levels, and missed/refused call volume.
• Assist with responding to member inquiries via email
• Maintain personal metrics to establish performance levels of the team
• 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
• Maintain completion of special projects, as assigned. This includes, but is not limited to, member outreach and follow-up.
• Assist in the grievance and appeals process
• Perform verification calls for members who have enrolled in the HealthTeam Advantage plan, as well as perform welcome calls to those members who do not require a verification call
• Perform outreach calls for members who have enrolled and require provider attestation or HRA completion.
• 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)
• Ability to work either the 8:00 AM-5:00 PM, 8:30 AM-5:30 PM, 9:00 AM-6:00 PM, or 11:00 AM-8:00 PM Monday through Friday outside of the 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.
• All other duties as assigned.

EDUCATION AND EXPERIENCE 

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

Preferred Experience:

• Healthcare Concierge experience
• Medicare Experience

Other Requirements:

• Annual Flu Vaccine

KNOWLEDGE, SKILLS, AND ABILITIES 

Required Competencies:

• Call Center/Customer Service Experience
• 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 

Preferred Competencies: 

• Thorough knowledge of CMS guidelines, processes, and systems 

PHYSICAL REQUIREMENTS 

• Exerting up to 10 pounds of force occasionally (up to 1/3 of the time) and/or
• A negligible amount of force is frequently (1/3 to 2/3 of the time) required to lift, carry, push, pull, or otherwise move objects, including the human body.
• Sedentary work involves sitting most of the time but may include walking or standing for brief periods.
• Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.