Retention & Eligibility Advisor

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

📋 Description

• Manage all elements of the USFHP member retention initiative.

• Engage with members to ensure ongoing enrollment.

• Identify and monitor reasons for disenrollment and associated trends.

• Develop and propose policies and procedures aimed at enhancing member satisfaction and retention.

• Analyze reports on disenrollment, complaints, grievances, and member feedback.

• Coordinate outreach efforts to members considering disenrollment.

• Collaborate with the Enrollment Department regarding issues related to member disenrollment.

• Create and deliver educational seminars and presentations for members.

• Support training and quality improvement initiatives.

• Conduct exit interviews with disenrolling members and offer best-practice recommendations to senior management.

• Present business cases advocating for retention strategies and assess campaign outcomes.

• Formulate retention strategies informed by consumer feedback.

• Work alongside the internal growth team on retention campaigns.

• Manage loyalty and retention programs designed to win back, reward, and retain members.

• Serve as a liaison between members and health plan teams.

• Collaborate with the member service escalation team to resolve issues promptly.

• Write and present reports on consumer behavior within the CRM database.

• Conduct discussions to identify reasons for dissatisfaction and work towards member retention.

• Process disenrollment requests within the CRM system.

• Adhere to policies, procedures, laws, and guidelines set by the Department of Defense, Defense Health Agency, and state regulations.

• Develop and maintain monthly reports on disenrollment and retention in collaboration with BI analysts.

• Assist with outbound call volume as necessary.

⛳️ Requirements

• Associate’s degree or a comparable combination of education and experience.

• Over 3 years of experience with Tricare or USFHP.

• Experience in direct interaction with health plan beneficiaries.

• Strong knowledge of TRICARE benefits is preferred.

• Familiarity with managed care concepts.

• Excellent telephone and interpersonal communication skills are essential.

• A strong commitment to customer service is required.

• Ability to work efficiently and independently.

• Analytical skills for research and problem resolution are necessary.

• Proficient computer skills, including fast data entry and high accuracy.

• Capability to collaborate effectively with other departments.

• Ability to multitask and prioritize effectively.

• Highly organized with strong follow-up skills.

• Ability to manage crisis situations and adapt to changes.

• Skill in designing work processes that cater to customer needs and expectations.

• Ability to establish accountability.

• Not eligible for immigration sponsorship.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• Retirement savings with employer contributions

• Paid time off

• Volunteer time off

• Pie day

• Additional employee benefits

• Potential for extra incentive or commission-based compensation, where applicable