Senior Member Service Representative

Corporate Square; San Antonio (TX); On-site; USD 40,000 - 55,000; Full time

Job summary

A leading healthcare organization is looking for a dedicated individual to serve as a liaison for STAR Kids and STAR+PLUS programs. This role involves resolving issues, ensuring compliance with regulations, and providing comprehensive support to both members and healthcare providers. Candidates are expected to have relevant educational and professional experience in healthcare or customer service, making this an excellent opportunity to contribute to a significant aspect of member services.

Qualifications

• Minimum two years college level work in business, health care administration or related courses.
• Four years experience as a customer service representative is required.
• Health care problem resolution experience is preferred.

Responsibilities

• Serve as a liaison regarding benefits and services for STAR Kids and STAR+PLUS programs.
• Ensure compliance with HIPAA policies.
• Answer a high percentage of STAR Kids hotline calls.

Skills

Customer Service

Problem Resolution

Communication

Education

Two years college level work in business

Healthcare Administration

Job description

POSITION SUMMARY/RESPONSIBILITIES
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 regards 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.

EDUCATION/EXPERIENCE
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 year of HMO experience is required. Health care problem resolution and experience with special healthcare members is preferred.