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United States
ConnectiCare Hiring for Member Navigator (7 Positions) at New York, NY Full Time
Summary:
- Perform outreach to identified members with the targets of closing care gaps, getting Health Risk Assessments (HRAs) completed, explaining complicated service interactions, improving member satisfaction with EmblemHealth, and enabling higher retention of members.
- Collaborate with enterprise teams on outreach to enhance understanding including:
- Care Management to understand members with gaps in care, and those needing to have HRAs completed, and which members are eligible by each care management program.
- Service Delivery and Analytics teams to understand which members may have had a negative experience with EmblemHealth.
- Sales, Product and Analytics teams to understand which members are at a risk for leaving the plan and identify which members to target for outreach and retention.
- Various Department leads for outreach to members who have had a negative experience due to system complications.
- Utilize knowledge of EmblemHealth’s products and services to serve as a positive brand ambassador for the enterprise in all interactions.
- Work primarily remotely, but position requires occasional attendance at a physical office location.
Responsibilities:
- Conduct outreach to members based on identified gaps and needs; respond to customer needs and help solve issues related to coverage and transactions, provide information on care management programming and help enroll members in applicable programs, understand and assist with additional customer operational needs related to the health plan, coverage and benefits possible, and document any further follow-up needed specifically from clinical/care management.
- Document interactions in support of quantitative metrics for the site and department.
- Perform research and analysis to identify trends and root causes.
- Work closely with enterprise teams to identify member needs on care gaps closures, HRA completions, care management program enrollment and risk for disenrollment; review assigned member’s profiles and experience, including all interactions with EmblemHealth, and prioritize for outreach.
- Prepare for outreach by customizing available scripting based on individual member needs and gaps.
- Participate in weekly meetings with manager and team members to discuss customer concerns, improvement opportunities (people, processes, and technology), and other company priorities.
- Perform ad hoc customer facing calls based on additional identified needs.
- Maintain ongoing learning on EmblemHealth products and services, including any recent changes in business rules or decisions that may impact customer experience.
Requirements:
- Bachelor’s Degree required: Additional experience may be considered in lieu of educational requirements
- 3 – 5+ years of experience working with customers in customer service, medical or managed care environment required
- Experience in evidence-based health and lifestyle coaching techniques preferred
- Willingness to attend appropriate training and certification classesr required
- Experience communicating directly with customers, assessing needs, and connecting customers with resources required
- Knowledgeable on how to navigate all aspects of medical care and managed care system, health, and wellness preferred
- Ability to demonstrate excellent service knowledge and hospitality required
- Possesses optimistic warmth and empathy for the customers’ experience required
- Technologically savvy, with the ability to quickly learn and navigate different information technology systems required
- Flexibility to travel to, and work in a physical office site when needed required
Additional Information
- Job Type: Standard
- Schedule: Full-time
- Employee Status: Regular
- Requisition ID: 1000000798
- Hiring Range: $52,000-$92,000
