Medicare Retention Specialist-Health Plan Place

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

Leads the team in the retention of members that are enrolled in the Medicare Advantage product. Coordinates and facilitates events in the community. Represents Presbyterian in the community statewide and via phone; serves as presenter/facilitator/educator at events.
Leads interactions with multiple levels within the organization and department as well as with external partners/agencies and the public. Creates outreach and programming communications. Leads the process and ensures compliance with the communications team.
Researches, compiles, analyzes, and interprets data to create reports and presents outcomes to management. Requires excellent communication, analytic, organization, and time management skills. Handles all escalated walk-ins and phone calls regarding members that need health plan support or want to disenroll in plan or have complaints. Leads tier 3 escalations and supports staff when needed. Specializes in de-escalation.
Uses discretion, independent thinking and decision making to develop solutions to overcome barriers and create process improvement strategies.

Some key responsibilities include:

• Must be able to understand both business and member views to communicate necessary information so that it meets both business needs and member experience requirements.
• Leads the Outreach Plan and supports the Volunteer Committee, including preparation of all materials.
• Targeted retention and sales goals.
• Identifies and resolves issues, escalates as necessary
• Leads special projects.
• Responsible for creating and tracking same day resolution tiered tracking
• Compiles and analyzes internal and external data to define unique needs and preferences of targeted populations as well as national and local market analysis of best practices.
• Presents data to management to facilitate decision making with information on preferences and unique needs of these populations; applies learning to recommend innovative approaches to educate and acquire targeted populations.
• Develops and maintains standard and ad hoc reports relative to outreach activities; routinely reports outcomes to management and team.
• Identifies opportunities to automate reporting processes; creates and documents business processes in flowcharts, workflows, job aides, work instructions, etc.
• Leads as the liaison with external contractors and internal departments specific to Health Plan Place.
• Break down, execute, and prioritize
• Identify problems, alternatives, and solutions to challenges
• Understands policy and performs work directly related to policies.
• Resolve conflicts
• Proactively prioritize time-sensitive requests and meet urgent and tight deadlines
• High degree of independent problem solving and critical thinking skills
• Required to lift 50 pounds
• Performs other functions as required

Qualifications:

• Associates degree required, 3 additional years experience may be substituted in lieu of degree, plus 3 years of experience in customer service preferably in managed care or health care.
• Requires strong organizational skills and the ability to understand plan/benefit details.
• Demonstrated abilities through education and/or work experience.
• Extensive knowledge of health care industry and health insurance systems and processes.
• Excellent written and verbal communications skills
• Strong relationship building skills, with ability to work in a highly matrixed environment.
• Expert computer skills including, but not limited to Microsoft Word, Excel, Access, Outlook; Adobe Acrobat.
• Preferred experience using workflow software (like Visio or Blueworks), Business Objects, Facets.
• Ability to orchestrate multiple activities simultaneously to accomplish a goal, as well as use resources effectively and efficiently.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.