Coordinates member outreach to ensure effective use of health plan benefits and to improve member health outcomes within the Medicaid or Medicare population. Responds to member inquiries in person; via telephone; and in writing.
- Identifies potential resources and initiates collaboration with community centers; mental health centers; faith/ethnic-based social service organizations; and school organizations to improve member health outcomes and HEDIS measures.
- Makes outbound calls to members to provide assistance in obtaining services (i.e.; provide reminders; make appointments; arrange transportation; etc.) to avoid delays in treatment and improve member health outcomes. Identifies when to refer member to Social Worker or Case Manager.
- Investigates and responds to member inquiries regarding benefits in person; via telephone; and in writing.
- Distributes educational information to members by most appropriate method (mailings; social media; automated calls; etc.) to help them utilize benefits more effectively.
- Develops educational/outreach materials including but not limited to incentive documents; call scripts; event flyers; social media text; etc.
- May develop and maintain member incentive programs to support HEDIS initiatives. Maintains incentive database to track member compliance.
- May identify opportunities to partner with community organizations on special events and presentations (i.e.; health fairs and community events) to heighten awareness of Coventry?s name. Works with internal staff to schedule; organize; and staff these events.
- May document complaints and grievances from members and refer them to the appropriate department for timely resolution.
- Performs other duties as required.
- High school degree or equivalent. Bachelor's degree preferred.
- Previous (3-5 years) outreach experience working with the Medicaid or Medicare population required.
- Previous customer service experience in a call center environment preferred.
- Demonstrated written and verbal communication skills.
- Ability to work independently.
- Ability to use standard corporate software packages and corporate applications.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer; and we are committed to building a talented and diverse team.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Primary Location: Wheeling, WV, US
Organization: 23000 - HealthAmerica Pennsylvania Inc
Job Posting: 2013-02-07 00:00:00.0
Job ID: 1310449
In May of 2013, Coventry became a part of Aetna. We are excited to join together with common values and a common mission: empowering people...