Role and Responsibilities

The Healthcare Concierge should have relevant customer service experience, preferably with Medicare experience and specifically with Medicare Advantage programs and be familiar with PPO’s and HMO’s. 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.

Healthcare Concierge I

Duties to include:

• 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 established 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, follow-up, etc.;
• Assist in grievance and appeals process;
• Perform verification calls for members that have enrolled in the HealthTeam Advantage plan as well as perform welcome calls to those members that do not require a verification call; and,
• Perform outreach calls for members that have enrolled and require provider attestation or HRA completion.

*Must be able 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)

**Must be able to work either the 8:00 AM-5:00 PM, 8:30 AM-5:30 PM or 11:00 AM-8:00 PM Monday through Friday outside of Annual Enrollment Period and 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.

The position description is not all inclusive and I may be required to perform other duties as assigned.

Education/Experience:

• High School diploma, GED, or equivalent work experience;
• Experience in customer service, sales, or account management experience; and,
• Experience in managed care or health plan operations.
• 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; and,
• Operate general office equipment, including but not limited to computers, phones, and related devices.
• Thorough knowledge of CMS guidelines, processes, and systems preferred.

Qualifications/Skills

Physical Requirements

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