Member Support Specialist II
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Job Description
Member Support Specialist supporting PacificSource health-plan members with healthcare navigation, referrals, and case-management coordination. Serving Georgia members remotely with approximately 20% travel for in-person support.
Responsibilities:
- Develop and implement goals and plans with case managers to help members navigate the healthcare system
- Educate members on understanding and working within their benefit structure
- Use motivational interviewing and patient-engagement techniques to support optimal health outcomes
- Identify community resources and make appropriate referrals
- Serve as liaison between members and providers/agencies
- Identify members for coordination and case management services using claims data and reports
- Screen requests for appropriate case management referrals from internal and external sources
- Collaborate with the case management team and participate in case management/care coordination meetings
- Ensure compliance with state and federal regulations, HIPAA standards, and confidentiality requirements
- Maintain accurate and timely documentation
- Assist with referrals, appointment scheduling, and transportation to medical appointments
- Assist members with non-clinical needs during transitions and phases of care
- Manage mailing lists and outgoing mailings
- Assist with departmental procedures, reports, and projects
- Assist care management in meeting government-regulated quality measures
- Enter and collate data and prepare assigned reports
- Participate in committees and make small-group presentations
- Perform other duties as assigned
Requirements:
- Minimum of three years of experience in community services or healthcare agencies focused on coordination services
- Experience in health insurance and delivering group presentations preferred
- High school diploma or equivalent required
- Knowledge of medical terminology
- Proficient in Microsoft Office, including Word, Excel, and PowerPoint
- Experience with medical management software, such as CaseTrakker Dynamo
- Excellent verbal and written communication skills
- Ability to work independently and effectively on a team
- Good working knowledge of how to access community resources and the healthcare system
- Ability to meet department and company performance and attendance expectations
- Ability to stoop and bend
- Ability to sit and/or stand for extended periods
- Ability to perform repetitive typing, sorting, and filing
- Ability to lightly lift and carry files and business materials
- Ability to read and comprehend written and spoken English
- Ability to communicate clearly and effectively
- Approximately 20% travel required
Benefits:
- Telephonic and in-person member support
- Work inside in a general office setting with ergonomically configured equipment
- Equal opportunity employment
- Participation in quality improvement initiatives
- Participation in team, department, company, and community-related committees
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