Member Outreach Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute inbound and outbound outreach activities to Medicaid members as per designated campaigns.

• Identify and engage with members selected by the health plan for outreach purposes.

• Foster relationships with members and their caregivers to uncover healthcare and social obstacles.

• Inform members about their healthcare benefits, available services, programs, and incentives.

• Assist in scheduling appointments for preventive care, follow-ups, annual wellness checks, behavioral health, maternal care, and chronic illness management.

• Provide support during welcome calls, redetermination outreach, benefits education, and initiatives aimed at re-engaging members.

• Help reconnect members with limited healthcare usage to suitable care options.

• Arrange transportation for healthcare appointments.

• Link members to food, housing, transportation, and various community resources.

• Refer members to care management or care coordination services when necessary.

• Aid health plan quality improvement initiatives and efforts to address gaps in care.

• Recognize urgent or complex member needs and escalate them as required.

• Record member interactions, needs, referrals, resolutions, and outcomes in the mandated systems.

• Adhere to approved outreach scripts and follow established policies and procedures.

• Engage in mandatory training, meetings, and educational sessions.

• Modify outreach priorities in response to changing member and health plan needs.

⛳️ Requirements

• Prior experience in healthcare, managed care, Medicaid, customer service, social services, community outreach, or a call center setting is preferred.

• Excellent interpersonal and customer service abilities.

• Capability to communicate effectively with individuals from various backgrounds.

• Strong problem-solving skills with the ability to assess member needs.

• Comfortable with frequent outbound telephone outreach.

• Exceptional organizational skills and the ability to follow through on tasks.

• Ability to manage multiple members and outreach priorities at once.

• Proficient computer and documentation skills.

• Capacity to maintain confidentiality and adhere to HIPAA regulations.

• Familiarity with Indiana Medicaid programs and community resources is preferred.

• Bilingual abilities are an advantage.

• Availability to work full-time, 40 hours per week.

• Flexibility for evening or weekend outreach if required.

🏝️ Benefits

• Health insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• 80 hours of paid time off (PTO) after 90 days of employment.

• 10 paid holidays throughout the year.