• Member Engagement Representative

    Job Locations US-VA-Chesapeake
    Job ID
    2018-5142
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Member Engagement Representative (MER) is responsible for informing, assisting and educating members enrolled in Virginia Premier Elite Plus (MLTSS) on how to properly use the medical services available to them. The MER position is responsible for receiving inbound and making outbound calls to members. The MER will handle and document all member inquiries, schedule transportation requests, verify eligibility and make necessary referrals and other related issues in an effort to provide information and facilitate and/or coordinate appropriate resolutions. The MER will build and maintain relationships in order to retain members.

    Responsibilities

    • Actively participate in developing and maintaining a cohesive customer service team that is focused on providing excellent customer service.
    • Assist management in achieving established department production and quality goals through individual and team efforts.
    • Assist members in identifying community resources by providing telephone numbers where the resources can be accessed.
    • Assist members on how to properly use the medical services available to them.
    • Build and maintain relationships in order to retain members.
    • Conduct outbound telephone calls consistent with programs promoting health plan education, health and wellness for members.
    • Document member/provider inquiries, complaints, hospital notification, and other data in CRM in an accurate, clear, and timely manner.
    • Establish and maintain good working relationships with others in the organization.
    • Maintain the call production standards as set by the department.
    • Plan and facilitate Member Advisory Committee Meetings for members.
    • Print and or mail cards for new or existing members.
    • Provide information, facilitate and/or coordinate appropriate resolution of member issues.
    • Respond accurately and courteously to member and provider inquiries regarding benefit interpretation, eligibility, claims status, accessing care through plan providers, and other related issues under the Basic Health Plan.
    • Schedule Regular, Cyclical and Multiple transportation trips for members.
    • Verify member eligibility for physician offices, ancillary providers, and hospitals.
    • Make outbound calls as assigned.
    • Other duties as assigned.

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • High school diploma or equivalent required.
    • Associates degree preferred

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Knowledge of medical terminology
    • Excellent customer service skills including the ability to work with people with diverse needs in a respectful and courteous manner at all times.
    • Excellent human relations and interpersonal skills to deal effectively with seniors through telephone interaction.
    • Demonstrated oral communication skills including the ability to convey complex information in a way that is easily understood by the member.
    • Demonstrated written communication skills particularly the ability to summarize notes in a clear, concise manner.
    • Computer literate with experience in Microsoft.
    • Ability to identify and solve problems creatively and with flexibility.
    • Ability to prioritize, organize, and complete daily work both independently and with team members as well as with or without routine supervision.
    • Ability to maintain a professional demeanor and confidentiality.
    • Ability to cope well under stressful situations.

    WORK BACKGROUND/EXPERIENCE

    • Minimum three year customer service experience (preferably in insurance, managed care, or a provider setting).
    • Experience in a call center environment strongly desired.
    • Experience with state programs (Medicaid) a plus.

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position 

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Need help finding the right job?

    We can recommend jobs specifically for you! Click here to get started.