The Customer Outreach Service Liaison I communicates to members in all lines of business (LOB) regarding: welcome and outbound calls, member Health Risk Assessment, and other related programs. The Liaison conducts and documents outreach activities (call, web, email) consistently and accurately. The Liaison proactively identifies, documents, investigates, and resolves member issues in a timely and appropriate manner. The Liaison also identifies potential areas of membership dissatisfaction and recognizes improvement areas.
The Liaison is responsible for facilitating member enrollment and outreach efforts, with a focus on:
* Health Risk Assessment- ensure to meet all regulatory requirements for Centers for Medicare and Medicaid Services (CMS), and for Seniors and Persons with Disabilities (SPD) population.
* Contact members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information is not provided on choice forms, enrollment applications, and data transmissions from applicable sources, etc. as well as the preferred threshold language and/or alternative format for receiving their welcome kits, network-related member notification letters, etc.
* Collaborate with internal and external stakeholders and members to facilitate continuity of care and the related enrollments and assignments (based on enrollment information for Covered California, permission-to-enroll forms, daily updates from PASC, COBRA/ICP elections, etc.)
* Process and screen applications and renewals for Healthy Kids members, notify applicants of the disposition of their application/renewal, and conduct the appropriate follow-up (including review of vendor outreach efforts)
* Work with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.
* Collaborate with Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, Personal Assistance Services Council (PASC), third party liability constituency, etc. staff to address and resolve questions, issues, etc. regarding member demographic information (e.g., CIN, name, address, and other related information) so that it can be appropriately updated and reflected in the system. Liaison also attends and participates in various internal and external meetings in this regard.