Bayside Solutions ยท 15 hours ago
Member Assessment Agent
United States
Contract
Remote
Entry Level
$50K/yr - $56K/yr
2+ years expBayside Solutions is seeking a Member Assessment Agent responsible for conducting member assessments and educating members about plan benefits. The role involves connecting members to community resources and ensuring compliance with regulatory standards.
Information TechnologyStaffing AgencyTelecommunicationsVirtual Reality
No H1B
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
Qualification
Required
Equivalent to a high school diploma or GED required
Minimum of two (2) years of work experience in a healthcare or managed care environment
Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint
Best practices in customer service, especially telephone-based services
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
Preferred
Experience working in a call center environment is highly preferred
Medicare and Medi-Cal programs are highly preferred
Company
Bayside Solutions
Bayside Solutions is a staffing and recruiting company offering IT, telecom, and scientific staffing services.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
B
Bob Klotz
Founder
Company data provided by crunchbase