• The primary purpose of the job is to:
• The Personal Care Connector (PCC) is a high-touch, extremely effective service specialist, responsible for supporting the daily operations of Medicare Member Services (Personal Service Program), integrated care management, and utilization management program interventions.
• The PCC performs in a contact center environment, effectively handling calls from Members, Providers and other areas, internal and external to the company.
• The PCC handles daily routine calls from Members & Providers in accordance with metric and performance requirements, identifies members with Care Gaps/HEDIS related health conditions and assists them in accessing care through Plan benefits and community resources.
• The PCC will handle all in/outbound calls and transactions directly supporting Clinical staff and assigned local teams, provide members with problem resolutions, educational materials, and carry out strategies to increase health care adherence to reduce barriers to care.
• Working knowledge of Medicare & Medicaid Required - (2-4 years preferred)
One to three years:
• Effective oral and written communication skills
• Ability to document case notes while speaking on the phone with customers
• Excellent customer service and interpersonal skills on telephone and in person
• Ability to handle multiple tasks simultaneously
• Act as interface and facilitator between members and provider offices
• Professionally handle incoming inquiries from customers regarding benefit eligibility or customer issues.
• Effective telephone skills to handle in-bound calls for triage and resolution
• Effective outbound call skills to deliver educational messages, collect health data, and critical thinking required to assess, triage, and offer solutions.
• Thoroughly and efficiently gather customer information, assess and fulfill customer needs and educate customers where applicable regarding products and services listed above.
• Ability to utilize and navigate multiple systems simultaneously.
• Be dependable and meet all attendance requirements.
• Resolve customer issues via one call resolution guidelines and/or escalated process.
• Meet or exceed company performance metrics including: availability on phone, occupancy, attendance, call handling quality, call documentation and routing on all calls handled, and adhering to all Regulatory Compliance requirements.
• Ability to provide solutions to customers while maintaining compliance and service objectives.
• Responsible for call disposition or compiling and generating reports as required.