Exception Template
700341 - Membership Retention Specialist
Position Purpose: The Membership Retention Specialist is responsible for activities related to strengthening customer relationships through member education relative to benefits and Plan usage and for local ""high touch"" outreach to improve membership retention of current and new Health Net Medicare Advantage, Part D members, CalMediConnect Members, etc.
Education/Experience:
Bachelor s degree in Sales, Marketing or other related field preferred. Minimum three years in sales and/or marketing, preferably in health care environment. Medicare experience strongly preferred.
License/Certification: Current insurance license for state in which product is sold, or ability to obtain license within 45 days of hire.
For PA plan and Medicare only: No licensure required.
"Acts as local resource and member advocate for members, supplementing the service work performed by the Customer Contact Center team.
May research CMC call sources, place outbound calls to CMC member or other service providers (e.g. pharmacist, physician office, etc.) to try and obtain updated contact information for the member
Responds to escalated member issues and attempts resolution to enhance member experience and minimize controllable disenrollments.
Interfaces with the Customer Contact Center to address member issues by the specific member situation.
Assists members with special circumstances and works with Care Management to coordinate service needs for covered benefits.
Provides management with statistical data and market information regarding member issues and reports.
Hosts member informational meetings during Annual Enrollment Period/Open Enrollment Period (AEP/OEP). Facilitates member requests for plan to plan changes during AEP/OEP.
Supports Sales during AEP/OEP, by interfacing with Field Sales Representatives, Seasonal Captive Agents and Sales Management team members.
Conducts new member orientation meetings to integrate new members into Health Net.
Provides education to existing and new members in person, over the telephone and through member meetings and other community outreach activities.
Develops relationships with senior centers, senior focused community organizations, contracted providers, and other community resources to facilitate higher levels of awareness and understanding of Health Net CMC product or Health Net Medicare Programs and the services and plans available in the Health Net of Arizona Medicare Advantage service area.
May promote the Health Net brand throughout the Medicare community and participate in various public relations opportunities.
Maintains and applies a high level of working knowledge regarding Centers for Medicare & Medicaid Services (CMS) regulations, particularly those related to Marketing and customer service.
Assists with plan change applications and ensures all necessary paperwork is completed and records are maintained.
Tracks and documents all member interactions, analyzes the associated data and makes recommendations to management to improve the customer experience.
Prepares reports from contact data regarding member retention activities and results in order to identify positive and adverse trends.
Participates in interdepartmental discussions and planning to evaluate procedures and processes and achieve company goals.
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
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700341 - Membership Retention Specialist
Position Purpose: The Membership Retention Specialist is responsible for activities related to strengthening customer relationships through member education relative to benefits and Plan usage and for local ""high touch"" outreach to improve membership retention of current and new Health Net Medicare Advantage, Part D members, CalMediConnect Members, etc.
Education/Experience:
Bachelor s degree in Sales, Marketing or other related field preferred. Minimum three years in customer service, sales and/or marketing, preferably in health care environment. Medicare experience strongly preferred.
License/Certification: Current insurance license for state in which product is sold, or ability to obtain license within 45 days of hire.
For PA plan and Medicare only: No licensure required.
- "Acts as local resource and member advocate for members, supplementing the service work performed by the Customer Contact Center team.
- May research CMC call sources, place outbound calls to CMC member or other service providers (e.g. pharmacist, physician office, etc.) to try and obtain updated contact information for the member
- Responds to escalated member issues and attempts resolution to enhance member experience and minimize controllable disenrollments.
- Interfaces with the Customer Contact Center to address member issues by the specific member situation.
- Assists members with special circumstances and works with Care Management to coordinate service needs for covered benefits.
- Provides management with statistical data and market information regarding member issues and reports.
- Hosts member informational meetings during Annual Enrollment Period/Open Enrollment Period (AEP/OEP). Facilitates member requests for plan to plan changes during AEP/OEP.
- Supports Sales during AEP/OEP, by interfacing with Field Sales Representatives, Seasonal Captive Agents and Sales Management team members.
- Conducts new member orientation meetings to integrate new members into Health Net.
- Provides education to existing and new members in person, over the telephone and through member meetings and other community outreach activities.
- Develops relationships with senior centers, senior focused community organizations, contracted providers, and other community resources to facilitate higher levels of awareness and understanding of Health Net CMC product or Health Net Medicare Programs and the services and plans available in the Health Net of Arizona Medicare Advantage service area.
- May promote the Health Net brand throughout the Medicare community and participate in various public relations opportunities.
- Maintains and applies a high level of working knowledge regarding Centers for Medicare & Medicaid Services (CMS) regulations, particularly those related to Marketing and customer service.
- Assists with plan change applications and ensures all necessary paperwork is completed and records are maintained.
- Tracks and documents all member interactions, analyzes the associated data and makes recommendations to management to improve the customer experience.
- Prepares reports from contact data regarding member retention activities and results in order to identify positive and adverse trends.
- Participates in interdepartmental discussions and planning to evaluate procedures and processes and achieve company goals.
- Travel May be required occasionally.
|
| Story Behind the Need |
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
| Strengthen customer relationships through member education and processes relative to benefits and Plan usage for local "high touch outreach to improve membership retention of current and new members.
Backfill for FTE.
Our culture surrounds the company s mission: Transforming the health of the communities we serve, one person at a time. It is a culture grounded in a shared set of values (accountability, courage, curiosity, trust and service) and behaviors that were developed based on feedback from team members across the organization.
No. |
| Typical Day in the Role |
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
| Member Retention Specialists are well rounded professionals who provide white gloves service to all individuals (members, providers) and cross-functional departments. We are responsible for processing value-added benefits-VAB (extra benefits not offered by standard Medicaid coverage) among other duties, which help guide our retention and outreach strategies. We provide member education and follow up on escalations, etc. regarding benefits, invoice processing and other tasks assigned. May need to make outreach member calls on a daily basis.
Process a minimum of 250 benefits Weekly and maintain a 95% or higher monthly quality score.
The flexibility it offers. |
| Candidate Requirements |
| Education/Certification | Required: HS Diploma | Preferred: Bachelor s degree in Sales, Marketing, or a related field, or equivalent experience. |
| Licensure | Required: N/A | Preferred: |
Years of experience required: - Minimum of three years in customer service, sales and or marketing, preferably in a health care environment.
Disqualifiers: Any gaps in work history (sporadically). PLEASE NOTE IF POSITIONS WERE CONTRACT OR FT ROLES AS WELL AS THE REASONING BEHIND THE END OF CONTRACT/ROLE)
Additional qualities to look for:- Medicare experience preferred.
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- Top 3 must-have hard skills stack-ranked by importance
| 1 | Communication |
| 2 | Problem-Solving |
| 3 | Time Management |