Member Support Specialist

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

📋 Description

• Act as a resource for members facing intricate psychosocial challenges that hinder adherence to medical regimens and optimal health outcomes.

• Provide support to members through telephone and in-person interactions.

• Collaborate with case managers to establish and execute personalized goals and plans for members.

• Educate members regarding their benefit structures.

• Employ motivational interviewing and patient engagement strategies to promote optimal health outcomes.

• Recognize community resources and facilitate suitable referrals.

• Function as a liaison between members and healthcare providers/agencies.

• Identify members in need of coordination and case management services utilizing claims data and reports.

• Evaluate requests for appropriate case-management referrals.

• Work in conjunction with the case-management team and engage in case-management/care-coordination meetings.

• Ensure adherence to state and federal regulations, HIPAA standards, confidentiality, and accurate documentation.

• Aid with referrals, appointment scheduling, and transportation to medical appointments.

• Assist members with non-clinical needs during transitional phases of care.

• Manage mailing lists and oversee outgoing mailings.

• Support departmental processes, reports, and projects.

• Contribute to care management quality measures mandated by government regulations.

• Enter, compile data, and prepare designated reports.

• Participate in assigned committees.

• Conduct small-group presentations.

• Engage in quality-improvement initiatives.

• Execute other duties as assigned.

⛳️ Requirements

• A minimum of three years of experience in community services or healthcare agencies focusing on coordination services.

• Preferred experience in health insurance and delivering group presentations.

• High school diploma or equivalent is required.

• Familiarity with medical terminology.

• Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint.

• Experience with medical management software, such as CaseTrakker Dynamo.

• Exceptional verbal and written communication abilities.

• Capacity to work independently as well as collaboratively within a team.

• Solid understanding of how to access community resources and navigate the healthcare system.

• Ability to meet departmental and company performance and attendance standards.

• Proficient in reading and understanding written and spoken English.

• Ability to communicate with clarity and effectiveness.

• Capability to stoop, bend, sit, and/or stand for prolonged periods, perform repetitive typing/sorting/filing activities, and lightly lift and carry files and business materials.

• Willingness to travel approximately 20% of the time.

🏝️ Benefits

• Equal opportunity employment.

• Work-from-home option available in North Carolina.

• Travel required approximately 20% of the time.

• Ergonomically designed equipment provided.

• Participation in quality improvement initiatives.

• Involvement in team, department, company, and community-related committees.

• At-will employment.