Humera - Administrative and Professional Staffing

Health Plan Specialist II

Minnetonka, MN, United States
Contact For Rate
Oct 05, 2017
Oct 16, 2017
Job Type
Employment Status
Full Time
Humera is looking for multiple Health Plan Specialist II's for our client, a major healthcare provider, in Minnetonka, MN. The calls received by the candidates will be transactional. This entry-level position is responsible for managing basic inquiries from active, terminated, and prospective members of this company. The Health Plan Specialist II is a primary contact for members to resolve service problems for claims, enrollment, billing, and pharmacy as well as interpreting contracts and explaining benefits. They are responsible for exceptional levels of service satisfaction.
    The degree of client satisfaction and retention that this company achieves with membership is directly related to the success of the customer service teams. The Health Plan Specialist II is responsible for identifying members and researching enrollment requests in a timely and courteous manner. Health Plan Specialist II's are expected to work with enrollment, billing and other departments within this company to resolve member issues. This is a contract to hire opportunity.
    The intention of the Government Programs Contact Center hiring class is to start quality candidates who will be level II (Medicare - CHA). Medicare Contact Center II - Center for Health Aging (CHA)
    • Supports Medicare member population that has either Individual or Retiree Group coverage
    • Takes approximately 45 inbound calls per day
    Care Coordinated Products (CCP)

    • Supports Dual-Eligible (Medicare & Medicaid) Members whose health plan benefits are administered by Medica. Products include Medica AccessAbility & Medica Dual Solutions.
    • Provide-A-Ride facilitates transportation to medical appointments
    • The hours of operation are: 8:00 AM - 5:00 PM, Monday through Friday

    Health Plan Specialist (HPS) Position Overview

    • Treat customers with respect and courtesy and act with the customer in mind
    • Represent Medica to the customer in a professional manner
    • Maintain and restore customer relationships with Medica
    • Work efficiently by utilizing online tools and resources
    • Resolve customer issues with a high degree of accuracy and timely follow-up to maintain customer trust and satisfaction
    • Provide end-to-end resolution of all issues by maintaining ownership and retaining all documentation to ensure complete, accurate and timely resolution.
    Department Expectations

    • Strong focus on the member experience
    • Enjoy working as part of a team and collaborating with peers
    • Maintain schedule adherence - 30 minutes scheduled lunch and two 15 minute scheduled breaks
    • Meet attendance guidelines - one of the most critical elements of this assignment
    • Meet department metric standards in:
    • Quality - Calls are regularly monitored and audited for quality assurance
    • Productivity - Average Handle Time / Calls Per Hour
    • Attend Friday department meetings scheduled from 8:00 AM - 9:00 AM
    • Follow the Medica dress code: Business casual Monday - Thursday; Casual on Friday
    • 100% of calls are recorded; any call may be audited for quality assurance
    • Contractor KPI (Key Performance Indicators): Attendance, Quality, and Productivity
    • Have a positive attitude, be engaged, ask questions?and have fun!

    • 1-2 years customer service experience required
    • Associate's degree or equivalent work experience required. Bachelor's degree preferred.

    • Team interaction and support of each other in dealing with customer issues.
    • Advanced ability to multi task and manage time efficiently
    • An ability to identify process improvements
    • Provide mentor and peer feedback
    • Develop knowledge of multiple products and platforms
    • Demonstrated ability to learn quickly and respond well to a rapidly changing industry and operational environment
    • Excellent verbal and written communication skills

    • 2 weeks of training. Hours are (8:00am - 5:00pm) for training with a 1 hour lunch

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