What are the responsibilities and job description for the Member Experience Specialist position at Upper Peninsula Health Plan?
POSITION: Member Experience Specialist
DEPARTMENT: Strategic Initiatives
BASE RATE: $20.41 per hour, with potential for additional compensation based on qualifications.
POSITION SUMMARY:
This position coordinates and prepares external communications for Upper Peninsula Health Plan (UPHP) members and providers. This position also facilitates government program enrollment and membership activities including grievance resolution. The Member Experience Specialist completes tasks and duties in accordance with established goals, objectives, and standards of the Upper Peninsula Health Plan.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Follows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential information.
2. Maintains knowledge of regulatory communications and marketing guidance including, but not limited to, Centers for Medicare and Medicaid (CMS) Managed Care communications and marketing guidelines, CMS plan communication user guide (PCUG), and Michigan Department of Health and Human Services (MDHHS) marketing requirements and guidelines.
3. Develops and coordinates interdepartmental reviews of major member materials such as Annual Notice of Change (ANOC), summary of benefits (SB), enrollment and disenrollment documents, member handbooks, and newsletters; responsible for the development and submission of member materials for all UPHP lines of business.
4. Conducts member outreach as needed.
5. Coordinates Medicare enrollment/disenrollment processes. Ensures enrollment process timeline parameters are met and daily Transaction Reply Reports (TRR) are addressed timely.
6. Responsible for investigation and timely resolution of member grievances for all lines of business. Compiles data, analyzes, and drafts grievance reports for CMS, MDHHS, and Department of Insurance and Financial Services (DIFS).
7. Processes returned member mail in accordance with applicable rules and regulations.
8. Reviews and demonstrates knowledge of National Committee for Quality (NCQA) measures and assists in NCQA evaluation activities related to member rights, responsibilities, and member experience.
9. Supports the MI Health Link Advisory Committee, including member recruitment, agenda development, meeting facilitation and reporting; serves as MI Health Link Advisory Committee Secretary and maintains meeting minutes.
10. Supports the Service Advisory Committee (SAC), including agenda development, meeting facilitation, and reporting; serves as SAC secretary and maintains meeting minutes.
11. Facilitates creation of provider newsletters in collaboration with appropriate staff.
12. Facilitates the UPHP policy maintenance process; ensures all policies are up-to-date, available to staff, and retained as required.
13. Coordinates the submission of Michigan Department of Health and Human Services (MDHHS) contract deliverables.
14. Facilitates interdepartmental workgroup to ensure the UPHP website is up-to-date.
15. Performs the day-to-day tasks required to support the Strategic Initiatives Department, which includes, but is not limited to, report drafting/review, document and project management, and government program document maintenance.
16. Enhances professional growth and development through participation in education programs, current literature, in-service meetings, and workshops.
17. Maintains confidentiality of client data.
18. Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS:
Education:
Minimum:
Associate degree in health information processing, business, or health-related field; four (4) years
of relevant experience in lieu of a degree will be considered.
Preferred:
Bachelor’s degree in business, health education, communications, or other health-related field
Experience:
Minimum:
Two (2) to three (3) years of insurance, marketing, or health-related customer service/education
(or combination of education and work experience)
Preferred:
Three (3) to five (5) years of insurance, marketing, or health-related customer service/education;
managed care and/or government programs experience
Required Skills:
Keyboarding proficiency
Working knowledge of MS Office (Word, Excel, and PowerPoint)
Excellent human relation and oral/written communication with advanced knowledge of vocabulary, spelling, proper grammar, and punctuation
Excellent organizational abilities with attention to detail
Proofreading, editing, and writing skills
Research and analytical skills
Ability to operate standard office equipment (photocopier/scanner, fax, etc.)
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements:
[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:
Ability to access departmental files
Ability to enter and access information from a computer
Ability to access all areas of the UPHP offices
Moderate physical effort (lift/carry up to 25 pounds)
Occasionally lifts supplies/equipment
Occasional reaching, stooping, bending, kneeling, crouching
Prolonged periods of sitting
Occasional prolonged standing
Manual dexterity and mobility
Working Conditions:
Works in office conditions, but occasional travel may be required
Subject to many interruptions
Occasionally subjected to irregular hours and evening meetings
Salary : $20
