Member Assessment Agent

W2 Contract

Salary Range: $49,920 - $56,160 per year

Location: San Mateo, CA - Remote Role

Job Summary:

Responsible for conducting member assessments, educating members of plan benefits, and connecting members to community partner agencies and other community resources. The agent will work closely with various departments within the company to ensure regulatory compliance.

Duties and 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.

Requirements and Qualifications:

• Equivalent to a high school diploma or GED required.
• Minimum of two (2) years of work experience in a healthcare or managed care environment.
• Experience working in a call center environment is highly preferred.
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Medicare and Medi-Cal programs are highly preferred.
• 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

Bayside Solutions, Inc. is not able to sponsor any candidates at this time. Additionally, candidates for this position must qualify as a W2 candidate. 

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