Member Liaison Specialist
Member Liaison Specialist
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4-5years
$ $ 25 - 30
1 Vacancy
Job Description
Company Overview: Our client is a leading healthcare located in Orange CA seeking a member liaison specialist who provide member service to seniors persons with disabilities or chronic conditions persons without housing and persons under the age of twentyone (21) who participate in the WholeChild Model program.
Position Summary: The successful candidate should have at least 2 years of experience in a call center and has additional 2 years of experience assisting with members in need (people with disabilities and chronic medical conditions).
Work Duration: Up to 6 months
Work type: Onsite
Position Responsibilities:
Assesses members concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.
Intakes information from members both over the phone and/or in person to complete requests for assistance cases grievances and appeals per departmental guidelines.
Coordinates members health care and social service needs both within and outside the health network during the original interaction.
Addresses member and provider inquiries questions and concerns in all areas including enrollment claims benefit interpretation coordination of care and referrals/authorizations for medical care related to services covered under the WholeChild Model program.
Guides members in understanding and accessing the benefits under the WholeChild Model program.
Maintains documentation of member cases within the FACETS system.
Initiates referrals to internal and external care management departments and government agencies.
Communicates with communitybased organizations health networks providers and vendors on behalf of members to resolve disputes and helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services.
Complete additional assignments and projects as assigned.
Experience & Education:
High School diploma or equivalent required
At least 2 years of experience working as a call center agent or customer/member services representative in health care dealing with HMO MediCal / Medicaid
2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity.
Bilingual in English and one of languages (Arabic Chinese Farsi Korean Spanish or Vietnamese)
Necessary Attributes:
Establish effective relationships with internal and external stakeholders.
Demonstrate independent judgment and decisionmaking skills.
Communicate effectively both verbally and in writing.
Flexible schedule availability for evening and weekend events.
Strong organizational analytical and problemsolving abilities.
Proficiency in Microsoft Office (Word Outlook Excel PowerPoint) and jobspecific applications/systems.
Sunshine Enterprise USA is an Equal Opportunity Employer Minorities Females Veterans and Disabled Persons
Proficiency in advanced anesthesia techniques for cardiac surgeries. Strong knowledge of critical care principles and management of cardiac conditions. Excellent communication and interpersonal skills, with the ability to work collaboratively in a fast-paced, high-pressure environment. Detail-oriented with strong organizational skills. Ability to make quick and informed decisions during medical emergencies.
Education
Minimum of 3 years of experience in cardiac anesthesia and ICU care, preferably in a hospital or healthcare setting with a high volume of cardiac surgeries. Demonstrated expertise in managing critically ill cardiac patients in the ICU.
Employment Type
Full Time
