Senior Member Services Representative
About The Position
POSITION SUMMARY/RESPONSIBILITIES Has comprehensive knowledge of STAR Kids and STAR+PLUS programs in order to serve as a liaison to members and providers regarding benefits and services, resolving member and provider issues, providing information regarding all aspects of the Special Health Care Needs (SHCN) call center which includes STAR Kids and STAR+PLUS program either by phone or in person. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies such as Abuse, Neglect and Exploitation (ANE), Fraud, Waste, and Abuse (FWA) in regards to all aspects of operations within Member Services. Staff designated at primary to STAR Kids hotline must answer 95% of STAR Kids calls. Maximum call duration limits are not imposed. Calls are of sufficient length to ensure adequate information is provided to caller.
Requirements
- Minimum two years college level work in business, health care administration or related courses is required or four year experience as a customer service representative.
- Minimum of two year of HMO experience is required.
Nice To Haves
- Health care problem resolution and experience with special healthcare members is preferred.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
251-500 employees
