Medicare Member Engagement Representative

Serves as a Medicare Member Engagement Representative primarily responsible for completing Medicare Advantage plan changes over the phone utilizing a compliance approved script. Documents all calls. Tracks and follows-up with SummaCare Medicare members at risk for disenrollment from the health plan. Assists with outreach programs designed to increase retention of SummaCare Medicare members. Acts as support when presenting plan benefit information to groups or individuals in person as needed. Has working knowledge of and complies with Center for Medicare and Medicaid Services (CMS) rules and regulations related to Medicare Advantage plans. Minimum Qualifications: 1. Formal Education Required: a. Bachelor s degree or equivalent combination of education and/or experience which has provided skill in servicing/retaining customers 2. Experience & Training Required: a. Has experience performing same or similar responsibilities. Relevant experience includes any combination of the following: customer service experience dealing with Medicare beneficiaries understanding of Medicare / health insurance compliance and a working knowledge of Medicare plan design and benefits. 3. Required Licenses and/or Certificates a. Valid driver s license. 4. Software and Data Entry Requirements: a. Word Excel and Microsoft Outlook at a basic level preferred b. SummaCare Plan Central member portal and WiPro eligibility system (receives training) c. MACESS MARx and Amisys systems as necessary 5. Other Skills Competencies and Qualifications: a. Ability to communicate accurate instructional and operational information (including the quoting of Medicare plan and benefit information) verbally and in written form that may include correspondence reports and instructional materials. Ability to interact with internal staff management Medicare beneficiaries and the general public. b. Attention to detail. c. Ability to quickly/efficiently apply and/or access principles of logical thinking to define problems collect data establish facts draw valid conclusions and prepare recommendations. d. Project empathy confidence proper tone and service-oriented attitude when communicating with internal and external customers. e. Organize and manage time to accurately complete tasks within designated time frames in fast-paced environment. f. Maintain confidentiality of member health information and business information. g. Maintain current knowledge of and comply with regulatory departmental and company policies & procedures. h. Flexible; ability to adjust work hours to meet business demands. 6. Other Skills Competencies and Qualifications: a. Performs plan changes for existing members changing from one SummaCare plan to another. b. Makes outbound calls to SummaCare members at risk of disenrollment. Tracks data required and documents calls in call management system (Macess). c. Makes outbound calls to SummaCare members who have recently joined the plan. Tracks data required and documents calls in call management system (Macess). d. Maintains knowledge of Medicaid system including MyCare Ohio program for dual-eligible population based on level of Low Income System (LIS) eligibility. e. Performs outreach calls to existing members in regards to incomplete application info; assist members in process to obtain Part B answer questions and educates on plan benefits and guidelines for members who have indicated they may leave SummaCare as needed. f. Provides timely internal and external customer service in cooperative professional and respectful manner. g. Participates in departmental outreach events/meetings as needed and performs other functions as assigned by the director. Note: The above stated duties are intended to outline those functions typically performed by the incumbent in this position. This description of duties is not intended to be all-inclusive nor to limit the discretionary authority of supervisors to assign additional tasks