What are the responsibilities and job description for the Member Liaison Specialist position at VGroup Inc?
For more details, please connect with Brij Kishore at 609-371-5400 Ext 331 or email at Brijt@vgroupinc.com.
Direct Client : CalOptima Health
Job Title : Member Liaison Specialist
Duration : 06 Months
Start Date : ASAP
Location : 505 City Parkway West, Orang, CA Onsite 92868
Position Type : Contract
Interview Type : In Person / Web Interview
Ceipal ID : CAL_HD438_MZ
Position ID : 438
Description :
CalOptima Health is seeking a highly motivated an experienced TEMP - Member Liaison Specialist to join our team.
The Member Liaison Specialist (Customer Service) will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program.
The incumbent will serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues.
Duties & Responsibilities :
85% - Member Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department.
Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.
Intakes information from members, both over the phone and / or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.
Coordinates members' health care and social service needs both within and outside the health network and CalOptima Health during the original interaction.
Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals / authorizations for medical care related to services covered under the Whole-Child Model program.
Guides members in understanding and accessing the benefits under the Whole-Child Model program.
Maintains documentation of member cases within the FACETS system.
Initiates referrals to internal and external care management departments and government agencies. Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes and helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services.
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department.
Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.
Intakes information from members, both over the phone and / or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.
Coordinates members' health care and social service needs both within and outside the health network and CalOptima Health during the original interaction.
Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals / authorizations for medical care related to services covered under the Whole-Child Model program.
Guides members in understanding and accessing the benefits under the Whole-Child Model program.
Maintains documentation of member cases within the FACETS system.
Initiates referrals to internal and external care management departments and government agencies.
Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes and helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services.
10% - Administrative Support Collaborates with interdepartmental staff in call resolution as needed. Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines. Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health.
Collaborates with interdepartmental staff in call resolution as needed.
Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines.
Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health.
5% - Completes other projects and duties as assigned.
Minimum Qualifications :
High School diploma or equivalent PLUS 2 years of experience as a call center agent or customer / member services representative in health care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) required.
Preferred Qualifications :
2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer / member service capacity.
Health maintenance organization (HMO), Medi-Cal / Medicaid and health services experience.
V Group Inc. is an IT Services company that supplies IT staffing, project management, and delivery services in software, network, help desk, and all IT areas. Our primary focus is the public sector including state and federal contracts. We have multiple awards / contracts with the following states : CA, FL, GA, MD, MI, NC, NY, OH, OR, PA, SC, VA, and WA, CT, TN. If you are considering applying for a position with V Group or partnering with us on a position, please feel free to contact me with any questions you may have regarding our services and the advantages we can offer you as a consultant.
Please share my contact information with others working in Information Technology.
Website : www.vgroupinc.com
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