Member Quality & Concierge Coordinator

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

📋 Description

• Implement outbound outreach initiatives aimed at enhancing quality, Stars, CAHPS, retention, and engagement efforts.

• Reach out to members regarding Health Risk Assessments, preventive care screenings, medication adherence initiatives, Annual Wellness Visits, and opportunities for care gap closure.

• Provide education to members on plan benefits, supplemental benefits, rewards programs, and available healthcare resources.

• Arrange appointments and facilitate connections to healthcare providers, pharmacies, transportation services, care management teams, and internal departments.

• Identify obstacles to care and collaborate with members to help resolve these issues.

• Maintain follow-up actions that support the achievement of member goals.

• Address member concerns by coordinating with operational departments and vendor partners.

• Escalate issues requiring further intervention while ensuring ownership until resolution is achieved.

• Utilize approved scripts, workflows, and documentation standards to comply with quality and regulatory requirements.

• Relay member feedback, trends, barriers, and opportunities for improvement to leadership.

• Engage in quality reviews, calibration sessions, coaching, training, team meetings, huddles, and special projects.

• Record member interactions, outcomes, needs, concerns, appointments, and follow-up actions in the relevant systems.

• Comply with CMS regulations, Medicare Advantage requirements, HIPAA guidelines, and company policies.

• Uphold confidentiality and data security standards.

• Achieve productivity, contact, quality, and campaign performance targets.

• Perform additional duties as assigned.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• At least 2 years of experience in customer service, healthcare, contact center, member services, or a related field.

• Excellent verbal and written communication skills.

• Proven ability to establish rapport and trust with diverse populations.

• Strong organizational skills with an exceptional attention to detail.

• Capability to manage multiple priorities in a fast-paced setting.

• Proficient in Microsoft Office applications and customer management platforms.

• Ability to work independently while also contributing to team goals.

• Associate's or Bachelor's degree in a related field is preferred.

• Experience in Medicare Advantage, Medicaid, managed care, or healthcare is preferred.

• Familiarity with Stars, HEDIS, CAHPS, member engagement, or care gap initiatives is preferred.

• Experience in scheduling healthcare appointments or conducting healthcare outreach campaigns is preferred.

• Bilingual in English and Spanish is preferred.

• Experience with Salesforce, Genesys, or similar CRM/contact center platforms is preferred.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with company match.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and advancement.

• Supportive work environment with a focus on team collaboration.