Even MORE Service Liaison I

Job Category:  Customer Service
Department:  Even MORE Outreach & Service
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  4560

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Even MORE Service Liaison I will communicate to members in all LOB regarding: welcome calls, outbound calls, member -Health Risk Assessment, related programs by LOB . Conduct and document outreach activities (call, web, email) consistently and accurately. The Liaison will proactively identify, document, investigate,  and resolve member issues in a timely and appropriate manner. The Liaison will also identify potential areas of membership dissatisfaction and recognize 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 CMS and for SPD population.
   * Contacting members to obtain their selection of PCP/clinic, medical group, (and Plan Partner, where applicable) assignment if information was not provided on choice forms, enrollment applications, 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. 
   * Collaborating 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.)
   * Processing and screening applications and renewals for Healthy Kids members, notifying applicants of the disposition of their application/renewal, and conducting the appropriate follow-up (including review of vendor outreach efforts)
   * Working with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.
   * Collaborating with DPSS, Health Care Options, the Ombudsman, Covered California, 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 CalMediConnect members and well as SPD members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This aligned with  service level requirements. (40%)

Even MORE Service Liaison will track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. Liaison will also 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%)

Liaison to meet L.A. Care’s  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%)

Liaison will 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%)

Liaison to 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%)

Performs other duties as assigned. (10%)

Education

High School Diploma/GED or Associate's Degree

Experience

Required:
With High School Diploma/GED:
 a minimum of 2 years of customer service experience in a corporate setting.

Preferred:
Managed care or healthcare experience.

Additional Information

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

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Nearest Major Market: Los Angeles

Job Segment: Medical, Healthcare