Member Assessment Agent

Pay Rate: $26.56 - $33.59 per hour | Location: San Mateo, CA - Remote Role | W2 Contract

About the role

Responsible for conducting member assessments, educating members of plan benefits, and connecting members to community partner agencies and other community resources. The agent will work closely with various departments within our company to ensure regulatory compliance.

Responsibilities

• Conduct member assessment interviews and collect members' health history, primarily by phone.
• Clearly document responses, risks, and any barriers to accessing proper care in our systems.
• Confirm receipt and validate completion of member assessments received via mail, telephone, fax, email, in-person, online, and external partners.
• Confirm member eligibility and special flag status, e.g., hospice status.
• Exhaust all resources and make robust outreach attempts to follow up on open cases, including conducting member outreach by mail.
• Clearly document any member's complaints, including grievances and appeals.
• Validate, research, and reconcile any discrepancies identified through various systems, such as HEALTHsuite, and update member demographics as needed.
• Clearly refer and communicate pertinent health information to appropriate departments to facilitate assistance with the member.
• Participate in team meetings and contribute to quality improvement initiatives.
• Escalate member issues to the Member Assessment Supervisor as appropriate.

Requirements

• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
• Perform problem research, use analytical skills, and effectively influence positive outcomes.
• Develop and maintain strong professional relationships with a diverse range of people.
• Utilize a personal computer, including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook).
• Use initiative, work independently, and make sound judgments.
• Work under pressure and within strict timeframes.
• Interact well with a variety of people and work effectively as part of a cross-functional team.
• Bilingual skills in Tagalog (desired).

Skills

• Member Assessments
• Health Risk Assessments
• Member Interviews
• Health History Collection
• Health Plan Benefits
• Member Education
• Community Resource Referrals
• Member Outreach
• Case Follow-Up
• Eligibility Verification
• Hospice Status Verification
• Assessment Validation
• Healthcare Documentation
• Risk and Care Barrier Documentation
• Grievances and Appeals
• Complaint Documentation
• Data Validation
• Discrepancy Research and Reconciliation
• Member Demographic Updates
• HEALTHsuite
• Regulatory Compliance
• Cross-Functional Collaboration
• Quality Improvement
• Issue Escalation
• Customer Service
• Telephone Communication
• Written Communication
• Analytical Skills
• Problem-Solving
• Relationship Management
• Independent Judgment
• Time Management
• Microsoft Office (Word, Excel, PowerPoint, Access, Outlook)