Member Support Specialist

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

📋 Description

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

• Engage with members both telephonically and in person as a vital member of the case management team.

• Collaborate with case managers to create and implement member goals and plans.

• Educate members on how to navigate and understand their benefit structure.

• Utilize motivational interviewing and patient-engagement strategies to foster optimal health outcomes.

• Identify community resources and facilitate appropriate referrals.

• Serve as a bridge between members and healthcare providers/agencies.

• Use claims data and reports to identify members in need of coordination and case management services.

• Assess requests for suitable case-management referrals.

• Work alongside the case management team and contribute to care-coordination meetings.

• Ensure compliance with state and federal regulations, HIPAA standards, and confidentiality protocols.

• Keep accurate and timely documentation.

• Assist with referrals, scheduling appointments, and arranging transportation for medical visits.

• Support members with non-clinical needs during various care transitions and phases.

• Manage mailing lists and oversee outgoing mailings.

• Aid in departmental procedures, reports, projects, and quality measures.

• Input and organize data while preparing designated reports.

• Participate in committees and initiatives aimed at quality improvement.

• Deliver presentations to small groups.

• Carry out additional duties as assigned.

⛳️ Requirements

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

• Preferred experience in health insurance and delivering group presentations.

• High school diploma or equivalent is required.

• Strong knowledge of medical terminology.

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

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

• Excellent verbal and written communication abilities.

• Capability to work independently and effectively collaborate as part of a team.

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

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

• Proficiency in reading and understanding written and spoken English.

• Clear and effective communication skills.

• Physical ability to stoop, bend, sit or stand for extended periods, perform repetitive typing, sorting, and filing, as well as lift and carry files and business materials.

• Willingness to travel approximately 20% of the time.

🏝️ Benefits

• Competitive salary and comprehensive health benefits.

• Opportunities for professional development and career advancement.

• Supportive work environment focused on teamwork and collaboration.