What are the responsibilities and job description for the Member Relationship Liaison position at Pyramid Consulting, Inc?
Job ID: 25-59708
Pay Range: $30 - $32/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Outreaching to members and providers, researching complaint issues and determining root cause and providing resolution.
- Writing responses to department of insurance complaints and members.
- Utilize multiple systems to investigate escalated inquiries on Members/Providers and follow the Member/Provider experience from beginning to resolution.
- Manage resolution of activities in CRM, including HICS from CMS according to defined turnaround times.
- Collaborate with internal teams and external partners to resolve complaints and document issue and resolution in CRM.
- Conduct Member/Provider outreach based on a variety of trends such as frequent caller data and out of network claim denials.
- Ensure compliance with State and Federal laws, following State and Federal guidelines as well as the procedures for the plans and the Corporation.
- Recommend workflows and policy as a result of Member/Provider feedback and escalation data analysis.
- Work cross functionally with internal departments regarding client needs and requests, work procedures, gaps in policy, and other elements of supporting assigned clients and conduct member, provider and health plan telephonic education as needed.
- Document appropriate client specific information in CRM.
- Key skills; Data management/data analytics, Excellent Communication skills, written and verbal, Critical thinking and issues resolution.
- After attending training classes, this person should be able to research and resolve cases without excess supervision after 4 to 6 weeks.
- Data management/data analytics.
- Excellent Communication skills, written and verbal.
- Critical thinking and issues resolution.
- Bachelor’s/equivalent experience.
- Experience in the Health Insurance Industry.
- Supervisor, Lead experience.
- Knowledge of Marketplace (ACA) plans preferred.
- Teams, SharePoint, Excel, OneNote desirable.
Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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Salary : $30 - $32
