Member Support Specialist II

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

📋 Description

• Collaborate with case managers to create and execute goals and plans that assist members in navigating the healthcare landscape.

• Provide education to members on how to understand and utilize their benefit structure effectively.

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

• Identify and connect members with relevant community resources through appropriate referrals.

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

• Use claims data and reports to identify members who require coordination and case management services.

• Screen incoming requests to ensure proper case management referrals from both internal and external sources.

• Work alongside the case management team and engage in case management and care coordination meetings.

• Ensure adherence to state and federal regulations, as well as HIPAA standards and confidentiality protocols.

• Maintain precise and timely documentation of all relevant activities.

• Support members with referrals, appointment scheduling, and transportation for medical visits.

• Assist members in addressing non-clinical needs during various transitions and care phases.

• Manage mailing lists and oversee outgoing mailings.

• Aid in departmental procedures, reporting, and project work.

• Support care management in achieving government-mandated quality measures.

• Enter and organize data, and prepare assigned reports.

• Participate in committees and deliver presentations in small group settings.

• Carry out additional duties as assigned.

⛳️ Requirements

• A minimum of three years’ 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.

• Familiarity with medical terminology is essential.

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

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

• Strong verbal and written communication skills are a must.

• Ability to work both independently and collaboratively within a team setting.

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

• Capable of meeting departmental and company performance and attendance requirements.

• Ability to stoop and bend as needed.

• Capacity to sit and/or stand for extended periods.

• Proficient in repetitive tasks such as typing, sorting, and filing.

• Ability to lightly lift and carry files and business materials.

• Competence in reading and comprehending written and spoken English.

• Ability to communicate clearly and effectively.

• Willingness to travel approximately 20% of the time is required.

🏝️ Benefits

• Telephonic and in-person support for members.

• Work in a general office environment equipped with ergonomically designed furniture.

• Commitment to equal opportunity employment.

• Involvement in quality improvement initiatives.

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