What are the responsibilities and job description for the Health Plan Member Support Specialist position at Bayside Solutions?
Health Plan Member Support Specialist
W2 Contract
Salary Range : $52,000 - $62,400 per year
Location : South San Francisco, CA - Onsite Role
Job Summary :
Join our team as a Health Plan Member Support Specialist, where you will be the friendly voice guiding health plan members and providers through their inquiries. Your role is vital in ensuring that our members receive the support they need regarding health plan benefits and services. You will be the first point of contact, delivering quick, precise, and courteous assistance for a variety of health care-related questions.
Duties and Responsibilities :
- Manage a high volume of inbound and outbound calls and communications while delivering exceptional customer service in alignment with established quality metrics.
- Follow guidelines, call scripts, and available resources to adeptly respond to member and provider inquiries, ensuring confidentiality and compliance with HIPAA regulations.
- Resolve concerns with professionalism and cultural sensitivity, tailoring explanations to suit the understanding of each member.
- Handle grievances, appeals, and billing issues, escalating to the Grievance and Appeals department as necessary.
- Educate members and providers on eligibility, benefits, and the provider network, assisting with primary care physician selections.
- Utilize effective listening and judgment to categorize and document all interactions accurately, ensuring proper follow-up actions.
- Refer members to community partners and services as needed to support their diverse needs, including Behavioral Health and Recovery Services.
- Use professional judgment to escalate complex inquiries and collaborate with other departments to ensure members receive comprehensive support.
- Actively seek improvements in processes to enhance the member experience continuously.
- Participate in team meetings, training sessions, and share best practices to uphold departmental objectives.
- Conduct member outreach such as welcome calls, ensuring a warm reception to new members.
- Represent the company positively at health fairs and community events to foster relationships and outreach.
- Stay updated with quality, regulatory, and organizational guidelines relevant to your role.
- Engage in problem research and utilize analytical skills to influence positive outcomes for members.
- Maintain confidentiality of health information and adhere to privacy and security best practices.
Requirements and Qualifications :
Bayside Solutions, Inc. is unable to sponsor candidates currently. Applicants must qualify as W2 candidates.
Salary : $52,000 - $62,400
