Member Support Specialist II

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

📋 Description

• Act as a resource for members dealing with intricate psychosocial challenges that impact medical-regimen adherence and health outcomes.

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

• Collaborate with case managers to create and execute member-specific objectives and plans.

• Inform members about their benefit structures.

• Employ motivational interviewing and patient-engagement strategies.

• Recognize community resources and facilitate referrals.

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

• Identify members who require coordination and case management services using claims data and reports.

• Evaluate requests for appropriate case-management referrals.

• Partner with the case-management team and engage in care-coordination meetings.

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

• Maintain precise and timely documentation.

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

• Support members with non-clinical needs during transitional periods and phases of care.

• Manage mailing lists and oversee outgoing mail.

• Contribute to departmental procedures, reports, projects, and quality measures.

• Input and organize data and generate reports.

• Participate in committees and deliver presentations in small groups.

• Meet departmental and company performance and attendance requirements.

• Undertake additional duties as needed.

⛳️ 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, including Word, Excel, and PowerPoint.

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

• Exceptional verbal and written communication abilities.

• Capable of working independently as well as collaboratively in a team environment.

• Strong knowledge of accessing community resources and navigating the healthcare system.

• Ability to read and understand written and spoken English.

• Effective communication skills are necessary.

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

• Willingness to travel approximately 20% of the time.

🏝️ Benefits

• Equal opportunity employment.

• Work-from-home options available.

• Ergonomically designed equipment provided.

• Opportunity to participate in quality improvement initiatives.

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

• At-will employment.