Member Engagement Representative

Completes Medicare Advantage plan changes over the phone utilizing a compliance approved script. Documents all calls. Tracks and follows-up with Medicare members at risk for disenrollment from the health plan. Assists with outreach programs designed to increase retention of client Medicare members. Acts as support when presenting plan benefit information to groups or individuals in person, as needed. Complies with Center for Medicare and Medicaid Services (CMS) rules and regulations related to Medicare Advantage plans. Formal Education Required:High School Diploma or GED Associate's or BA/BS preferredExperience & Training Required:Two years of experience in a call center, customer service, or support role in the health insurance industry performing same or similar responsibilities which includes any combination of the following:Customer service experience dealing with Medicare beneficiaries,Understanding of Medicare / health insurance complianceWorking knowledge of Medicare, plan design and benefitsTwo (2) years of experience in the health insurance industry strongly preferred Other Skills, Competencies and Qualifications:Possess working knowledge of Center for Medicare and Medicaid Services (CMS) rules and regulations related to Medicare Advantage plansAbility to complete client plan and product training prior to open enrollment season with a passing rate of 90%.Ability to multi-task. Operate computer, MACESS member documentation system, Plan Central, Salesforce CRM system, utilize website and phone system while speaking and collecting information from member and when applicable prospective enrolleeExcellent phone skills. Strong understanding of Federal and State regulatory requirements and Marketing Guidelines. Able to work independently and within a team environment. Effective listening and critical thinking skills. Ability to develop, prioritize and accomplish goals. Demonstrate time management.Moderate Stress: Variety of work that is complex in nature; requires attention to detail; frequent interruptions and distractions; involves coordinating across departments. Accountable for personal performance and completion of projects across departments. Frequently required to calm and gain confidence of others. Ability to travel from location to location throughout the workday. Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity Provides exceptional personalized service to members by phone and in person regarding plan information, network and pharmacy questions and inquiries around changing from one plan to another.Assists member in selection of most appropriate plan based on information provided by member and with member input. Completes plan change request from one MA-PD plan to another.Assists with administrative tasks around tracking and monitoring of number of plan change requests received and other tasks to support successful completion of plan change requests.Makes outbound calls to members as needed during AEP timeframe to inform of specific plan or network changes/information.Assists with educating members who inquire to ensure member needs are met and their questions and concerns are addressed.Communicates to Medicare beneficiaries accurately to ensure understanding of the product choices available to them during the enrollment process and enrolls prospective beneficiaries into plan of choice.Adhere to all compliance and company rules and mandates set forth in the CMS marketing and compliance guidelines as well as in the company policies and procedures.Perform other assigned administrative duties as defined by management, including updates and maintenance of appropriate reporting and database systems.