Customer Solution Center Even MORE Service Liaison I (ALD) 12 Month Contract

Job Summary

The Customer Solution Center (CSC) Even MORE Service Liaison I communicates to members in all lines of business (LOB) regarding: welcome and outbound calls, member Health Risk Assessment, and other related programs. The Liaison conducts and documents outreach activities (call, web, email) consistently and accurately. The Liaison proactively identifies, documents, investigates, and resolves member issues in a timely and appropriate manner. The Liaison also identifies potential areas of membership dissatisfaction and recognizes improvement areas.

The Liaison is responsible for facilitating member enrollment and outreach efforts, with a focus on:

   * Health Risk Assessment- ensure to meet all regulatory requirements for Centers for Medicare and Medicaid Services (CMS), and for Seniors and Persons with Disabilities (SPD) population.

   * Contact members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information is not provided on choice forms, enrollment applications, and data transmissions from applicable sources, etc. as well as the preferred threshold language and/or alternative format for receiving their welcome kits, network-related member notification letters, etc.

   * Collaborate with internal and external stakeholders and members to facilitate continuity of care and the related enrollments and assignments (based on enrollment information for Covered California, permission-to-enroll forms, daily updates from PASC, COBRA/ICP elections, etc.)

   * Process and screen applications and renewals for Healthy Kids members, notify applicants of the disposition of their application/renewal, and conduct the appropriate follow-up (including review of vendor outreach efforts)

   * Work with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.

   * Collaborate with Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, Personal Assistance Services Council (PASC), third party liability constituency, etc. staff to address and resolve questions, issues, etc. regarding member demographic information (e.g., CIN, name, address, and other related information) so that it can be appropriately updated and reflected in the system. Liaison also attends and participates in various internal and external meetings in this regard.

Duties

Facilitate the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communication, including welcome calls and meeting all regulatory requirement for Health Risk Assessments for Medicare Plus DSNP members and SPD members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This is aligned with service level requirements. (40%)

Track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. Assist with coordinating with other departments to follow up and resolve issues that arise through member contact, including potential care coordination/continuity of care issues. (20%)

Meet L.A. Care’s policy and procedure (P&P) requirements for attendance and follow department guidelines and expectations. Collaborate with the CSC Departments regarding member enrollment efforts for all lines of business. (15%)

Assist with identifying and assessing areas of potential member dissatisfaction (PQI) as well as focusing on opportunities for service/process improvement. This is in compliance with regulatory requirements for auditing purposes. (10%)

Assist Business Units and Product Lines with the implementation and completion of special projects, including member loyalty programs. Collaborate with internal and external peers to enhance the integrity of member information and ensure continuity of care and increase member retention. (5%)

Perform other duties as assigned. (10%)

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 1 year of customer service call center experience in a healthcare environment. 

Data entry experience with ability to type a minimum of 40 wpm. 

Preferred:

Previous automatic call distribution (ACD) experience.

Skills

Required:

Knowledge of medical terminology.

Good understanding of service to the disadvantaged population, seniors and/or people with chronic conditions or disabilities. 

Must be a quick learner, excellent team player and customer service oriented. 

Ability to answer a high volume of calls.

Preferred:
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information