Senior Member Service Representative

University Health System; San Antonio (TX); On-site; USD 40,000 - 60,000; Full time

Job summary

A leading healthcare provider is looking for a liaison for STAR Kids and STAR+PLUS programs. The candidate will provide member support, ensure HIPAA compliance, and have a strong background in customer service or healthcare administration. Ideal for individuals with healthcare experience and problem-resolution skills, this role supports critical services for special healthcare needs.

Qualifications

• Customer service experience preferred, with HMO experience.
• Understanding of STAR Kids and STAR+PLUS programs.

Responsibilities

• Serve as a liaison for benefits and services in STAR Kids and STAR+PLUS programs.
• Ensure compliance with HIPAA policies.
• Answer STAR Kids hotline calls with 95% response rate.

Skills

Healthcare problem resolution

Customer service

Education

Minimum two years college level work in business or 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.