Health Program Representative - Call Center
Responsible for providing initial contact between distinct Care Management programs and specific identified members. Under direct supervision handles inbound/outbound enrollment and engagement calls with eligible members to provide information regarding program features. Primary duties may include, but are not limited to: Gathers and records appropriate member information in accordance with policies and procedures via telephone. Encourages members to participate in the Care Management programs by providing information about the program, outlining program features/value and explaining available services. Records call details and utilize call scripts as needed based on client requirements. Directs member inquiries to appropriate clinical staff. Initiates referrals and manages consults from clinicians for participants registered in Care Management. Gathers information from hospitals, health plans, physicians, patients, vendors and other referral sources. Contacts physician offices to obtain demographic information or related data as needed.
- Telephonic Outreach to membership to scheduled appointment with PCP
- Provide members with information on how to access preventive services while identifying barriers to care
- Documents member participation of member outreach activities as appropriate
- Records and reports all member outreach activity
- Invite members to provider clinic days to receive health check services
- Educate and engage members on health benefits and importance of preventive care services
- 80 ??? 100 calls per day
- 30 appointments scheduled per week
Working hours: 8 AM - 5 PM
- One of more years of health related experience. i.e. call center experience, community outreach worker.
- Managed care call center experience
- Some understanding of medical terminology
- Computer literacy in excel and word
Requires HS diploma or the equivalent; 6 months experience in a telesales or customer service demonstrating ability to influence customers/ members; or any combination of education and experience, which would provide an equivalent background. Computer/keyboarding proficiency and the ability to follow defined policies and protocols required.
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