Job Summary:

The ProCare Advantage Health Plan Liaison will service as the customer services member advocate and respond to and resolve provider, facility and member/responsible party inquiries and issues within established time frames.

This position is considered a work-from-home position as no formal office space/work location is necessary. They will conduct the majority of their work throughout the State of Texas and is ideally central to Dallas. Travel to San Antonio, Beaumont, and Houston will be necessary.

ProCare Advantage has formed an Institutional Special Needs Plan (I-SNP), which is a form of Medicare Advantage Plan. As an I-SNP, we will be covering the medical costs of people who are eligible for Medicare and who reside in our partner nursing facilities.

Qualifications:

• Demonstrated Organizational Skills.
• Two or more years of experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker, caregiver or other related role. Nursing home experience is preferred;
• Currently hold a license to sell health insurance in Texas and be in good standing with the licensing board; or, ability to pass the educational requirements and testing required to obtain the license in Texas.
• Documented successful sales experience in healthcare market preferred.
• Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans.
• Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback provided by family members.
• Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages.
• Ability to work well with staff at each of the nursing homes in the assigned region to include nursing staff, doctors and administration staff.
• Ability to deliver outstanding customer service with a proven track record.
• Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current drivers license, a clean driving record, and proof of insurance.
• Strong proficiency in computer skills in Microsoft Office Suite products.

Essential Functions:

• Respond to and resolve provider, facility and member/responsible party inquiries and issues within established time frames.
• Provide monthly roster of enrollees and ID cards to the facility leadership.
• Contact/Visit all facilities at least once a month to ensure relationship is in good standing and triage any issues identified by the facility staff back to the appropriate Procare department.
• As a Responsible Party or eligible resident indicates interest in the plan, serve, answer questions about the plan, and facilitate a warm handoff to a Sales Agent who will enroll the resident in the plan.
• Follow up with members to ensure that any questions are answered, act as a point of contact if the member or their family needs assistance with the plan or provide them with periodic updates about the plan.
• Act as front-line support as needed with the member, partner facility and integrated care team to ensure the needs of the Member and Plan are met.
• Develop and maintain relationships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements.
• Conduct quarterly customer service surveys with the members and/or their family; based on the results of the survey, follow up on any items with which the members are dissatisfied

Diversity, Equity, and Inclusion are at the heart of Cantex. We are committed to a culture that respects our differences and values the contributions of all people.

Please visit cantexcc.com for more information on this location.

We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package.