Essential Duties and Responsibilities:

- Interface with clients and refer complaints or inquiries to appropriate departments, agencies, advocates, or client representatives.

- Stay updated on managed care relevant to supported client programs.

- Adhere to processing guidelines, protocols, and contract requirements for complaint processing and handling PHI/PII.

- Assist consumers in health plan enrollment, disenrollment, and transfers when necessary.

- Fulfill assigned duties directed by the Complaint Unit Supervisor or Project Management.

- Meet performance standards outlined in the annual criteria and bonus template for the position.

- Address complex customer service inquiries and problems over the telephone, noting consistent issues for resolution.

- Potentially respond to email inquiries.

- Prioritize customer service as the primary function, handling non-routine calls requiring deviation from standard procedures.

- Manage situations needing adapted responses or extensive research based on customer needs.

- Utilize computerized systems for tracking, information gathering, and troubleshooting.

- Handle escalated or unresolved calls from less experienced representatives.

- Tackle moderately difficult assignments, exercising judgment in issue resolution and recommending solutions.

- Conducts outreach including phone calls, home visits, and community presentations in the field in accordance with project policy and procedures (50% of the time). Solely responsible for a specific geographic area and related tasks for that area. Travels independently using proper safety precautions.
- Conducts one-on-one and group outreach presentations to recipients and community members within a specific territory or initiative. The work environment varies and is mobile.
- Presents program education and enrollment options to recipients to encourage recipient action. Presents managed care options to recipients and assists them in using their health care and dental plans and community resources as needed.
- Identifies, develops, builds, and maintains positive relationships with county staff, state agencies, and community/faith-based groups to enhance presence in the community.- Retrieves, researches, and analyzes data from multiple databases to answer client concerns and completes direct data entry into designated internal automated systems in accordance with EB Project policies and procedures.
- Identifies issues, problem-solves, and escalates unresolved issues and concerns to management immediately and regularly.
- Establishes and maintains knowledge of the community and participates in community events, health fairs, and other activities as needed.
- Multi-tasks in several computer applications at once while holding a conversation with client. Responsible for documenting activity in automated systems and reporting outcomes on a daily/ weekly basis. Responsible for ensuring confidentiality of client information.
- Uses customer service skills to adapt to situations and deal with clients face-to-face.
- Willingness to work a flexible schedule including weekends and evenings.
- Assists other Outreach Counselors and other team members with management and completion of daily duties to ensure compliance with contract standards and requirements.
- May be required to wear personal protective equipment (PPE) when having client in-person interaction for precautionary measures
- Provide customer service inbound support via telephone when needed to assist the EB Call Center department
- Performs other duties as may be assigned by management
Minimum Requirements
- High school diploma or GED required and 1+ years of relevant professional experience required, or equivalent combination of education and experience. Program Specific Requirements:
- Bilingual preferred (Spanish/English)- Required to travel within the region assigned- High School diploma, GED, or equivalent certification- DSHS Community Health Worker certification preferred.- One year of human services experience or experience dealing with the public.- Proficient in Microsoft Office products.- Knowledge of Excel required.- Ability to work with customers in a caring and respectful manner and with due understanding of and consideration for their unique circumstances.- Excellent organizational, written, and verbal communication skills.- Ability to perform comfortably in a fast-paced, deadline-oriented work environment.- Ability to work as a team member, as well as independently.- Must be able to remain in a stationary position for an extended period of time.- Occasionally lifts, carries, or otherwise moves items weighing up to 25 pounds.- Work is often performed conducting home visits, presentations, and part in an office environment.- Reliable transportation with proper insurance and a Texas Driver’s License that meets the State of Texas requirements.- Highly developed problem-solving skills preferred.- Demonstrated ability to build high-performing teams preferred.- Medicaid knowledge preferred EEO Statement Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.