Job Summary

The Retention Representative is responsible for providing exceptional customer service and support to members enrolled in Medicaid STAR, STAR+PLUS, CHIP, CHIP-P, Health Insurance Marketplace, and D-SNP plans. Reporting directly to the Retention Manager, the Retention Representative will handle inbound and outbound calls, addressing member inquiries, resolving issues, and assisting with plan retention efforts. The representative will be a key player in ensuring member satisfaction and retention by delivering accurate information and maintaining a positive relationship with members.

Job Specicification and Core Competence

• Participate in outbound call campaigns aimed at retaining at-risk members, providing necessary information, and ensuring they remain enrolled in their plans. Address and resolve member issues, concerns, and complaints in a timely and professional manner.
• Answer inbound calls and respond to member inquiries regarding plan benefits, enrollment, and services across Medicaid STAR, STARPLUS, CHIP, CHIP-P, Health Insurance Marketplace, and D-SNP plans.
• Provide accurate and clear information to members about their plans, benefits, and any changes that may affect them.
• Work closely with the Retention Manager and other team members to escalate complex issues and ensure that member concerns are addressed appropriately.
• Actively participate in training sessions and team meetings to improve service delivery and retention efforts.
• Adhere to all company policies and procedures, as well as federal and state regulations governing all plans. Actively participate in training sessions and team meetings to improve service delivery and retention efforts.
• Actively contributes to achievement of departmental goals, as identified in Department?s annual business plan, including specific departmental process improvement plans, and other duties as assigned.

QUALIFICATIONS:

• Education/Specialized Training/Licensure: High school diploma or equivalent required.
• 2 years relevant work experience of which: 1 (one) year of health care / plan, or other related experience
• Cross-functionality in Claims and Authorization Status, Benefits and Eligibility for at least two (2) lines of business for all Customer calls and/or electronic communication.
• Previous experience in a healthcare or insurance call center environment preferred.
• Other: Bilingual (English/Spanish) preferred.