USFHP Retention & Eligibility Advisor

Martin's Point Health Care•Portland, ME

9d•Onsite

About The Position

The Retention & Eligibility Advisor is responsible for overseeing all aspects of USFHP member retention program. This includes but not limited to, communicating with members to ensure members remain in the Plan, identify and track disenrollment reasons and trends to minimize dis-enrollments, and identify and implement member retention initiatives and strategies. Member retention plays a critical role in increasing member/brand loyalty and meeting corporate member standards. The retention specialist will work cross-functionally across Martins Point USFHP and with our members to increase loyalty and retain membership for USFHP. This includes listening to member’s reasoning for disenrollment through multiple data points and providing leadership recommended solutions. Candidate must have good communication, critical thinking skills, and the ability to be empathetic to the consumers’ needs and concerns.

Requirements

Associate’s degree or equivalent combination of education and experience.
3+ years of experience with Tricare or USFHP.
Experience working directly with health plan beneficiaries.
Deep knowledge of TRICARE benefit preferred.
Understanding of managed care concepts.
Excellent telephone and interpersonal skills required.
Strong commitment to customer service required.
Must be able to work efficiently and independently.
Must be analytical in research and problem resolution.
Strong computer skills (keyboard proficient, quick data entry and a high level of accuracy).
Able to work cooperatively with other departments.
Multi-task oriented with the ability to prioritize.
Well organized with excellent follow up skills.
Ability to handle crisis situations and can easily adapt to change.
Ability to design work processes around customer needs and expectations.
Ability to establish accountability.

Responsibilities

Develops and recommends policies and procedures regarding beneficiary issues with a focus on member satisfaction and retention.
Uses disenrollment reports, complaint and grievance data, and member feedback to analyze disenrollment trends and apply critical thinking to resolve gaps and potential gaps in Plan goals.
Coordinates outreach to pending disenrolling members.
Collaborates with Enrollment Department regarding issues involving the disenrollment of members of the Plan.
Creates and presents member educational seminars and other presentations, as required.
Supports training and quality initiatives.
Offer insight about best practices to senior management based on disenrollment exit interviews with beneficiaries.
Have some familiarity with statistical analysis and reporting methodologies.
Present business case module to senior management to promote specific retention strategies.
Evaluative campaign results.
Develop an aggressive retention strategy based on consumer feedback.
Work with the internal growth team on creation and preparation of new retention campaigns.
Responsible for coordinating the loyalty and retention programs designed to win back, reward, and retain members/beneficiaries.
Act as a liaison between member, health plan teams as needed.
Collaborate with member service escalation team to ensure member issues are addressed and resolved quickly.
Writing and presenting consumer behavior reports in the Consumer Relationship Management (CRM) database.
Engage beneficiaries in fact finding discussion to ascertain the reason for dissatisfaction.
Confirm reason and attempt to retain if possible.
Process all disenrollment request in our CRM.
Follow program policies and procedures consistent with Department of Defense, Defense Health Agency, and state laws and guidelines.
Develop and maintain up-to-date disenrollment and retention reports monthly through collaboration with Business Intelligence (BI) analysts.
Supplements outbound call volume when needed.