Medicare Retention Specialist-Health Plan Place

Presbyterian Healthcare Services

2d • Onsite

About The Position

Build your Career. Make a Difference. Presbyterian is hiring a skilled Medicare Retention Specialist to join our team.

Requirements

• Associates degree required, 3 additional years experience may be substituted in lieu of degree, plus 3 years of experience in customer service preferably in managed care or health care.
• Requires strong organizational skills and the ability to understand plan/benefit details.
• Demonstrated abilities through education and/or work experience.
• Extensive knowledge of health care industry and health insurance systems and processes.
• Excellent written and verbal communications skills
• Strong relationship building skills, with ability to work in a highly matrixed environment.
• Expert computer skills including, but not limited to Microsoft Word, Excel, Access, Outlook; Adobe Acrobat.
• Ability to orchestrate multiple activities simultaneously to accomplish a goal, as well as use resources effectively and efficiently.

Nice To Haves

• Preferred experience using workflow software (like Visio or Blueworks), Business Objects, Facets.

Responsibilities

• Leads the team in the retention of members that are enrolled in the Medicare Advantage product.
• Coordinates and facilitates events in the community.
• Represents Presbyterian in the community statewide and via phone; serves as presenter/facilitator/educator at events.
• Leads interactions with multiple levels within the organization and department as well as with external partners/agencies and the public.
• Creates outreach and programming communications.
• Leads the process and ensures compliance with the communications team.
• Researches, compiles, analyzes, and interprets data to create reports and presents outcomes to management.
• Requires excellent communication, analytic, organization, and time management skills.
• Handles all escalated walk-ins and phone calls regarding members that need health plan support or want to disenroll in plan or have complaints.
• Leads tier 3 escalations and supports staff when needed.
• Specializes in de-escalation.
• Uses discretion, independent thinking and decision making to develop solutions to overcome barriers and create process improvement strategies.
• Must be able to understand both business and member views to communicate necessary information so that it meets both business needs and member experience requirements.
• Leads the Outreach Plan and supports the Volunteer Committee, including preparation of all materials.
• Targeted retention and sales goals.
• Identifies and resolves issues, escalates as necessary
• Leads special projects.
• Responsible for creating and tracking same day resolution tiered tracking
• Compiles and analyzes internal and external data to define unique needs and preferences of targeted populations as well as national and local market analysis of best practices.
• Presents data to management to facilitate decision making with information on preferences and unique needs of these populations; applies learning to recommend innovative approaches to educate and acquire targeted populations.
• Develops and maintains standard and ad hoc reports relative to outreach activities; routinely reports outcomes to management and team.
• Identifies opportunities to automate reporting processes; creates and documents business processes in flowcharts, workflows, job aides, work instructions, etc.
• Leads as the liaison with external contractors and internal departments specific to Health Plan Place.
• Break down, execute, and prioritize
• Identify problems, alternatives, and solutions to challenges
• Understands policy and performs work directly related to policies.
• Resolve conflicts
• Proactively prioritize time-sensitive requests and meet urgent and tight deadlines
• High degree of independent problem solving and critical thinking skills
• Required to lift 50 pounds
• Performs other functions as required

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree