Mon- Friday 8-5
4 month temp contract
· Provide customer service to HPSM members/participants primarily on the phone.
· Answer member/participant questions and/or refer the member/participant to the appropriate outside agency.
· Educate members/participants about their rights and responsibilities.
· Explain the benefits of the program, how the plan works, and how to get care.
· Answer questions about provider network for appropriate product line.
· Process changes to member records such as primary care physician, demographic and other changes.
· Conduct welcome calls.
· Assist members in resolution of problems receiving covered services and complaints, in an effective, accurate and timely manner.
· Document all activities in HPSM System.
· Refer unresolved complaints to the Grievance and Appeals Unit.
· Prepare activity reports as required.
· Follow-up if member has selected a provider in Established Patient Only (EPO) status.
· Answer questions about providers; educate members on effective dates for PCP changes; assist members in selecting and changing their PCP.
· Participate in and professionally represent HPSM at health fairs, community partnerships, meetings, committees and coalitions as requested by the Manager or Supervisor.
· Work with entire Member Services department to continuously measure and improve the performance of the department and HPSM.
· Perform other duties as assigned.
Education and Experience: Equivalent to a high school diploma or GED required. One (1) year experience in a customer service environment highly desirable.
Knowledge of: Health insurance programs preferred. Customer service principles and practices. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
Other: ** SPANISH SPEAKING REQUIRED**