GA Member Specialist I - Portland
Martin's Point Health Care - Portland, ME

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The GA Member Specialist has the primary responsibility of supporting our GA members to ensure customer satisfaction, member retention, and compliance.

Key Outcomes:
  • Answers verbal, written and in-person inquiries from GA Members regarding the Medicare Plan benefits, claims, prescription benefits, policies, and procedures.
  • Answers claims and finance questions, including requesting review and reassessment of any errors.
  • Answers incoming telephone inquiries and resolves member complaints within the timeframes outlined in the Centers for Medicare and Medicaid service standards
  • Maintains excellent documentation of member inquiries, which provides detailed information of each inquiry, including the resolution of the inquiry. Documents all member inquiries in the QNXT system.
  • Provides ongoing education to GA Members about the Medicare Plan benefits, policies, procedures, providers, and pharmacies.
  • Coordinates the resolution of GA Member inquiries with other departments at Martin’s Point.
  • Assists GA members with Primary Care Provider (PCP) changes.
  • Mails materials regarding GA upon request
  • Updates the member/patient database by entering, verifying, or correcting demographic data of persons requesting information, assistance or complaint resolution.
  • Updates Caremark database to reflect accurate eligibility and LIS status for members with prescription benefits.
  • Delivers service in a courteous, friendly and professional manner, to both internal and external customers
  • Ensure that CareMark Rx issues regarding spend, authorization, process, verification of eligibility, and setting up mail order process are resolved in a timely fashion.
  • Mentors new and temporary GA Member Specialists

  • High school diploma or equivalent.
  • 2+ years experience in the area of customer/member services; preferably in a healthcare setting.

Skills/Knowledge/Competencies (Behaviors):
  • Excellent customer service skills
  • Ability to work efficiently and independently.
  • Analytical skills in research and problem resolution.
  • Strong computer skills (keyboard proficient, quick data entry with a high level of accuracy).
  • Able to work cooperatively with other departments.
  • Multi-task oriented with the ability to prioritize.
  • Detail oriented.
  • Well organized with excellent follow up skills.
  • Ability to handle crisis situations and easily adapt to change.

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