Member Assessment Representative - Health Plan- Bilingual- Spanish

Health Plan Member Assessment Agent- Bilingual- Spanish

Johnson Service Group is seeking a Health Plan Member Assessment Agent in South San Francisco Bay Area. This is a Hybrid position. Working from home but may need to come to office occasionally. Work Schedule: Monday- Friday, 8:30am- 5:00pm. Pay Range: $26.50-$33.50 DOE.

Job Description

Responsible for conducting member assessments, educating members of plan benefits, and connecting members to community partner agencies and other community resources. The agent will work closely with various departments within company to ensure regulatory compliance.

Essential Functions:

• Conduct member assessment interviews and collect members' health history, primarily by phone.
• Clearly document responses, risks, and any barriers to accessing proper care in company systems.
• Confirm receipt and validate completion of member assessments received via mail, telephone, fax, email, in-person, online, and external partners.
• Confirm member eligibility and special flag status, e.g., hospice status.
• Exhaust all resources and make robust outreach attempts to follow-up on open cases, including conducting member outreach by mail.
• Clearly document any member's complaints, including grievances and appeals.
• Validate, research, and reconcile any discrepancies identified through various company systems such as HEALTHsuite, and update member demographics as needed.
• Clearly refer and communicate pertinent health information to appropriate departments to facilitate assistance with the member.
• Participate in team meetings and contribute to quality improvement initiatives.
• Escalate member issues to Member Assessment Supervisor as appropriate.

Secondary Functions:

• Perform other duties as assigned.

Education and experience equivalent to:

• Equivalent to a high school diploma or GED required.
• Minimum of two (2) years of work experience in a healthcare or managed care environment.
• Experience working in a call center environment highly preferred.

Knowledge of:

• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
• Medicare and Medi-Cal programs highly preferred.
• Best practices in customer service, especially telephone-based services.

Abilities:

• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
• Perform problem research, use analytical skills, and effectively influence positive outcomes.
• Develop and maintain strong professional relationships with a diverse range of people.
• Utilize a personal computer including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook).
• Use initiative, work independently, and make sound judgments.
• Work under pressure and within strict timeframes.
• Interact well with a variety of people and work effectively as part of a cross functional team.

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more. Johnson Service Group (JSG) is an Equal Opportunity Employer. JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.