Member Support Specialist - Care & Benefits Outreach

Healthfirst

United States

On-site

USD 35,000 - 55,000

Full time

7 days ago

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Benefits offered by this job

Medical, dental, vision coverage

401k contributions

Incentive programs

Job summary

Healthfirst is seeking a Support Specialist to assist primary care/case managers with non-clinical tasks, including member outreach, provider communications, and processing service requests. Responsibilities include reviewing intake documents, initiating authorizations in Trucare, documenting calls, educating members and providers, and coordinating with other departments to resolve onboarding issues.

Minimum qualifications: high school diploma or GED and customer service experience; preferred:

Qualifications

High School diploma or GED equivalent.
Experience in a customer service environment.
Experience in fast-paced environment handling multiple priorities.
Strong verbal and written communication skills.

Responsibilities

Outreach to new enrollees to review services and requests.
Review intake documents for pre-approved services and escalate discrepancies.
Complete onboarding assessments and identify issues needing clinical escalation.
Initiate and finalize authorizations in Trucare for preapproved services and DMEs.
Document calls to assist with benefits, appointments, inquiries, issues, and grievances.
Document calls with providers regarding authorizations, referrals, visits, tests, and care plans.
Educate members and providers on service approvals requirements.
Manage a large caseload and coordinate with departments to improve outcomes.