Senior Member Services Representative

Community First Health Plans • San Antonio, TX

106d

About The Position

The position requires comprehensive knowledge of STAR Kids and STAR+PLUS programs to effectively serve as a liaison to members and providers. This includes resolving member and provider issues and providing information regarding all aspects of the Special Health Care Needs (SHCN) call center, which encompasses the STAR Kids and STAR+PLUS programs, either by phone or in person. The role also ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies, including Abuse, Neglect and Exploitation (ANE), and Fraud, Waste, and Abuse (FWA) in all operations within Member Services. Staff designated as primary to the STAR Kids hotline must answer 95% of STAR Kids calls, with no maximum call duration limits imposed, allowing for sufficient time to provide adequate information to callers.

Requirements

• Minimum two years of college-level work in business, health care administration, or related courses required.
• Four years of experience as a customer service representative required.
• Minimum of two years of HMO experience required.
• Experience in health care problem resolution preferred.
• Experience with special healthcare members preferred.

Responsibilities

• Serve as a liaison to members and providers regarding benefits and services.
• Resolve member and provider issues related to STAR Kids and STAR+PLUS programs.
• Provide information regarding all aspects of the Special Health Care Needs (SHCN) call center.
• Ensure compliance with HIPAA related policies, including ANE and FWA.
• Answer 95% of STAR Kids hotline calls as designated staff.
• Allow sufficient call duration to ensure adequate information is provided to callers.

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree