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Senior Member Services Representative
Job summary
A healthcare organization in San Antonio, Chile is seeking a knowledgeable candidate to assist with STAR Kids and STAR+PLUS programs. Responsibilities include liaising with members and providers, ensuring compliance with HIPAA policies, and resolving issues. Necessary qualifications include two years of college education in relevant fields or four years as a customer service representative, along with HMO experience. This role is essential in managing healthcare service inquiries effectively.
Qualifications
- Minimum two years college level work in business, health care administration or related courses required.
- Minimum of two years of HMO experience required.
- Preferred experience with health care problem resolution and special healthcare members.
Responsibilities
- Serve as a liaison to members and providers regarding benefits and services.
- Resolve member and provider issues and provide information on SHCN call center.
- Ensure compliance with HIPAA related policies.
Education
Has comprehensive knowledge of STAR Kids and STAR+PLUS programs in order to serve as a liaison to members and providers regarding benefits and services, resolving member and provider issues, providing information regarding all aspects of the Special Health Care Needs (SHCN) call center, which includes STAR Kids and STAR+PLUS program either by phone or in person. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies such as Abuse, Neglect and Exploitation (ANE), Fraud, Waste, and Abuse (FWA) in regard to all aspects of operations within Member Services. Staff designated at primary to STAR Kids hotline must answer 95% of STAR Kids calls. Maximum call duration limits are not imposed. Calls are of sufficient length to ensure adequate information is provided to caller.
Minimum two years college level work in business, health care administration or related courses is required or four year experience as a customer service representative. Minimum of two years of HMO experience is required. Health care problem resolution and experience with special healthcare members is preferred.
* The salary benchmark is based on the target salaries of market leaders in their relevant sectors. It is intended to serve as a guide to help Premium Members assess open positions and to help in salary negotiations. The salary benchmark is not provided directly by the company, which could be significantly higher or lower.