Member Engagement Specialist — HEDIS/STARs Focus

Blue Cross and Blue Shield of Massachusetts, Inc.; Hingham (MA); On-site; USD 41,000 - 50,000; Full time

Benefits offered by this job

Paid time off

Medical/dental/vision insurance

401(k)

Well-being benefits

Job summary

Blue Cross Blue Shield of Massachusetts, Inc. is seeking a Member Engagement Specialist in Hingham, MA. You will connect with members, schedule appointments, and refer to care management to improve health outcomes.

The role emphasizes flexibility to support team initiatives, including chart reviews and performance measurement. You will collaborate across Care Management, Member & Provider Service, and Performance Measurement teams to drive HEDIS/STARs results.

Qualifications

• Medical Assistant or equivalent health profession required.
• Prior Medicare experience preferred.
• Experience with clinical telephonic health coaching/call center preferred.

Responsibilities

• Make outreach calls to members with gaps in care to ensure adherence to HEDIS/STARs and contact provider offices to schedule appointments.
• Support RN Provided Screening by scheduling and confirming patient appointments and faxing providers/documents.
• Assist with non-clinical needs such as MyBlue registration and explaining gap-related benefits.
• Process faxed outreaches by calling offices to confirm status and obtain fax numbers.
• Identify barriers to obtaining care and refer to internal or external resources.
• Ensure timely documentation in required systems and meet daily productivity goals.
• Participate in Performance Measurement and Improvement activities like medical record reviews and provider outreaches.
• Provide onsite and virtual administrative support to HHIT and Clinical Quality Team for events.

Skills

Organization skills

Communication

Problem-solving

Education

Medical Assistant / Certified Pharmacy Technician

High school diploma or equivalent

Job description

Blue Cross Blue Shield of Massachusetts, Inc. is seeking a Member Engagement Specialist in Hingham, MA. You will connect with members, schedule appointments, and refer to care management to improve health outcomes.

The role emphasizes flexibility to support team initiatives, including chart reviews and performance measurement. You will collaborate across Care Management, Member & Provider Service, and Performance Measurement teams to drive HEDIS/STARs results.