Salary Range: $50,216.00 (Min.) - $62,770.00 (Mid.) - $75,324.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Customer Solution Center Even MORE Service Liaison I, will communicate to members in all line of business (LOB) regarding: welcome calls, outbound calls, member -Health Risk Assessment, related programs by LOB. Conduct and document outreach activities (call, web, email) consistently and accurately. The Liaison will proactively identify, document, investigate, and resolve member issues in a timely and appropriate manner. The Liaison will also identify potential areas of membership dissatisfaction and recognize 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 SPD population.
* Contacting members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information was not provided on choice forms, enrollment applications, 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.
* Collaborating 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.)
* Processing and screening applications and renewals for Healthy Kids members, notifying applicants of the disposition of their application/renewal, and conducting the appropriate follow-up (including review of vendor outreach efforts)
* Working with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.
* Collaborating with Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, 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.
Facilitate the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communication, including welcome calls and meeting all regulatory requirement for Health Risk Assessments for CalMediConnect members and SPD members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This is aligned with service level requirements. (40%)
Even MORE Service Liaison will track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. Liaison will also assist with coordinating with other departments to follow up and resolve issues that arise through member contact, including potential care coordination/continuity of care issues. (20%)
Liaison to meet L.A. Care’s P&P requirements for attendance and follow department guidelines and expectations. Collaborate with the CSC Departments regarding member enrollment efforts for all lines of business. (15%)
Liaison will assist with identifying and assessing areas of potential member dissatisfaction (PQI) as well as focusing on opportunities for service/process improvement. This is in compliance with regulatory requirements for auditing purposes. (10%) Liaison to assist Business Units and Product Lines with the implementation and completion of special projects, including member loyalty programs. Collaborate with internal and external peers to enhance the integrity of member information and ensure continuity of care and increase member retention. (5%) Perform other duties as assigned. (10%) Duties Continued Education Required High School Diploma/or High School Equivalency CertificateEducation Preferred Experience
Required:
At least 1 year of customer service experience in a corporate setting.
Demonstrated experience handling complex customer calls.
Preferred:
Managed care or healthcare experience.
Skills
Required:
Strong verbal and written and communication skills.
Strong organizational skills.
Preferred:
Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
Paid Time Off (PTO) Tuition Reimbursement Retirement Plans Medical, Dental and Vision Wellness Program Volunteer Time Off (VTO)