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Job Title: Member Advocate
Reports to: Director, Member Operations
Job description revision number and date: 1.0, 9/14/17
Community Care Cooperative (C3) seeks passionate, talented, and hard-working employees to help transform the health of underserved communities and directly contribute to improving the health and wellness of C3 members. C3 Member Advocates will serve C3 enrollees, helping them navigate the ACO and ensuring they understand their benefits, rights, and responsibilities.
Ideal candidates will deliver exceptional customer service, demonstrate empathy and strong communication skills, thrive in a productive, fast-paced environment, be comfortable fielding inbound calls on a wide range of topics, and placing outbound calls to engage enrollees in appropriate care and C3 programs. C3 is growing, and looking for team members who can adapt as the organization evolves. The successful candidate will be fluent in Spanish.
C3 is a new and innovative Accountable Care Organization (ACO), built around a group of Federally Qualified Health Centers (FQHCs) committed to providing coordinated, holistic, and culturally appropriate care in the communities where they live and work.
- Respond to member inquiries on a broad range of topics and in a variety of channels, primarily phone and including mail, email, and fax. Answer incoming telephone calls promptly, politely, and professionally.
- Appropriately access information, systems, and resources as needed to resolve enrollee or provider issues, ideally during initial contact. When necessary, triage to or connect with resources such as the language line, care management, MassHealth, or other entities.
- Provide education and assistance to members on ACO policies and procedures and enrollee rights and responsibilities, including grievances and appeals. Follow C3 and MassHealth grievance and appeals processes.
- Receive, respond, and triage other types of callers, including provider offices, the general public, media outlets, or others and route appropriately to resolve inquiries. Follow C3 policies and procedures for handling each type of caller.
- Conduct outbound calls as needed for a range of purposes, including but not limited to completing Care Needs Screening, engaging members in C3 or related programs, and following up to resolve outstanding issues. Document outbound call statistics and disposition according to C3 policies and procedures for each initiative.
- Accurately and thoroughly document all communications in the appropriate systems, in accordance with C3 policies and procedures, to enable monitoring, tracking, reporting, and analysis of call volume, outbound call disposition, and other statistics. Assist in reporting of those statistics as needed. Follow established regulations and procedures in collection, recording, storage and handling of information.
- Consistently meet contractual and C3 standards and expectations for call center performance (volume, timeliness, quality of service).
- Collaborate with C3 staff and partners to effectively answer inquiries and resolve issues.
- Protect and preserve confidentiality of all enrollee and C3 information at all times in accordance with HIPAA requirements and C3 policies and procedures.
- Follow processes for fulfilling member requests for information, ID cards, or other materials. Process returned mail according to C3 policies and procedures.
- Represent the ACO in the community or at public forums as requested.
- Maintain high standards of professional conduct. Comply with the all applicable C3 policies and procedures, expectations, and standards. Attend required training.
- Perform other tasks, duties, or projects as assigned.
Education and Experience:
- Prior experience in a health care setting and knowledge of health centers, managed care organizations, and/or MassHealth strongly preferred
- Associates degree preferred
- At least one year of experience working in customer service role a plus
Knowledge, Skills, and Abilities:
- Fluency in English and Spanish (oral and written) is required
- Ability, orientation, and commitment to provide outstanding customer service
- Highly developed sense of integrity
- Ability to communicate clearly and professionally, both orally and in writing
- Ability to actively listen, demonstrate patients and empathy, and authentically engage with individuals in a caring and helpful manner
- Ability to identify and resolve problems and maintain composure and sound judgment in difficult or stressful situations
- Knowledge of and/or ability to learn and adhere to HIPAA rules, MassHealth contractual requirements, and other applicable regulations
- Ability to learn new systems and tools, including for tracking/recording of contacts
- Ability to manage multiple priorities in an effective and organized manner
- Strong attention to detail
- Capacity to navigate a computer while on the phone
- Experience with core Microsoft Office products (e.g., Outlook)
Additional job opportunities will be posted soon; check back or email for more information.