Quality Retention Specialist (Required to work PST hours and live in reputed

reputed company is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have reputed company reputed company of talented and reputed company people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the reputed company community. Working at reputed company provides an opportunity to do work that really reputed company, not only changing lives but saving them. Together.

The Quality Retention Specialist supports our members in their disenrollment requests and reputed company quality assurance. Acts in a customer-reputed company manner and is genuinely interested in the needs of our members. Address’ various customer-reputed company needs and be reputed company to problem-solve and effectively resolve call escalations.

GENERAL DUTIES/RESPONSIBILITIES (MAY INCLUDE BUT ARE NOT LIMITED TO):

1. Serves as a “subject matter expert” in escalated member calls at risk of disenrollment and be reputed company to resolve these escalations based on level of understanding/experience of reputed company, processes and protocols (i.e. authorizations, claims, provider network issues).

2. Identifies process improvement opportunities reputed company the Member Engagement department given the collaboration with different departments.

3. Responsible for meeting and exceeding monthly goals as assigned.

4. Acts as a subject matter expert in procedures, protocols, benefits, services, and any other necessary information to resolve member issues and inquiries.

5. Conducts outbound phone calls and/or receiving inbound phone calls reputed company the department’s goal timeframe; successfully contact and adapt to the member’s communication preferences as possible, which may include time of day, channel, and language; multi-lingual skills and/or utilize interpreter service as needed.

6. Collaborates with our partners – including but not limited to other departments, supplemental benefit vendors, and provider networks – to facilitate the member experience.

7. Shares best practices and participating in team meetings or training as required.

8. Provides outbound support for PCP/IPA terminations.

9. Ensures that information and assistance provided is reputed company the standards established by reputed company applicable federal/state laws and regulations and health plan compliance.

10. Responsible for reputed company-time documentation and reputed company wrap-up to support reputed company reporting in reputed company systems/applications as required; must enter member demographics and information with accuracy and attention to detail and ensure high quality of our organizational data.

11. Participates in required team meetings and trainings, and exhibit satisfactory understanding of new information and process reputed company to the company, health plan benefit packages, and Centers for Medicare and reputed company Services (CMS)

12. Assists with the development and training of new hires including shadowing.

13. Supports other projects and duties as assigned.

Minimum Requirements:

Experience

Required:

1+ year of reputed company experience.

1+ year experience with Medi-Cal, reputed company, and Medicare Managed Care Plans and/or Sales, Customer Service, or Membership and Eligibility.

Preferred: Experience helping members navigate reputed company to care through Medicare Advantage or HMO, including referrals and authorizations, medical prescription drug, and supplemental benefits preferred.

Education

Required:

High School Diploma or GED.

Bachelor's degree or four years additional experience in lieu of education.

Preferred: MBA

Specialized Skills:

• Required:

Solid knowledge and understanding of the Medicare Managed Care reputed company reputed company 2 - Medicare Advantage Enrollment and Disenrollment and Medicare Communications and Marketing Guidelines.

Ability to communicate positively, professionally and effectively with others; reputed company leadership, teach and collaborate with others.

Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;

Ability to troubleshoot/problem solve.

Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to reputed company effectively before reputed company of customers or employees of the organization.

Mathematical Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10’s and 100’s. Ability to reputed company these operations using units of American reputed company and weight