Serves as a liaison to employer groups, members, brokers, and regulatory staff in resolving account service issues, contractual issues, provides information to Community First Health Plan customers by phone, mail or in person. Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA) related policies in regards to all aspects of operations within Corporate Communications & Marketing.
- Assists employer groups, brokers, and account representatives in determining nature of problem/complaint or request regarding CFHP. (E 20%)
- Resolves all urgent or complicated cases involving membership, related to contractual issues that need immediate attention. (E 15%)
- Educates employer groups, brokers, and account representatives as it relates to contractual services and benefits. (E 20%)
- Provides explanation of contractual obligations related to benefits and co-payment determinations. (E 10%)
- Assists, coordinates, and educates other departments regarding changes during commercial open enrollment to include changes and updates of new benefits to include, but not limited to, the Group Action Form process (GAF). (E 15%)
- Produces reports as well as maintains detailed processes, logs, and dashboards, of account services activities. (E 15%)
- Performs special projects and other duties as may be requested or assigned. (M 5%)
- Demonstrates competence to perform general and assigned responsibilities in manner that meets the age-specific and developmental needs of customers encountered. (E)
- Appropriately adapts general and assigned methods to accommodate the unique physical, psychosocial, cultural, age-specific and other developmental needs of customers. (E)
- Supports University Health System mission, vision and values. Demonstrates established customer service behaviors and standards. Treats all customers with courtesy, dignity, respect and professionalism. (E)
Supervision is received from the Senior Manager, Outreach Development.
Bachelor’s degree in Marketing, Public Relations OR a minimum of four years of supervisory work in health care administration, managed care; general health care industry which consists of strong customer service, outreach, and account services experience is required.
Valid Texas driver’s license is required.
Proficiency in performing all phases of assigned duties, thoroughness in reporting information to supervisor. Experience and keen presentation skills are required in all areas of outreach and member retention. Attention to detail, ability to work internally and externally without immediate supervision is required. Must be able to provide accurate information to ensure quality assurance in enrollment and eligibility as well as track and report any issues/concerns.
Knowledge and familiarity with standard office equipment, personal computer, and other special equipment utilized by Corporate Communications & Marketing department.
Functions in an office environment. Extensive travel may be required, mostly local. Subject to frequent interruptions and deadlines. Hours of work may vary.
Proven, outstanding skill in communication and relationship building with clients/customers both, internal and external is required. Should have positive leadership qualities to relate quickly to people and establish credibility. Must be able to work with various situation and changes. There is a high level of daily contact with the public. Must successfully complete the pre-employment/post job offer health screening examination and the annual health screening, each year thereafter, as an employee.
- Community First Health Plans
- Judy Razo