The Social Programs Representative conducts intake services from internal and external correspondence through telephonic inquiry. In addition to conducting telephonic outreach services, this position assists low-income Medicare beneficiaries with the qualification and application process for Medicare Savings Programs and other types of assistance, and educates on Medicare and Medicaid.
Essential Job Functions:
- Accurately pre-qualifies Medicare-eligible individuals per program guidelines and submits applications for approval on a timely basis, focusing on monthly production goals and conversion rate quotas.
- Conducts intake services from incoming correspondence, telephonic inquiries, and telephonic outreach activities. Analyses and assesses state Medicaid eligibility criteria for enrollment in Medicare Savings Programs.
- Maintains assigned caseload and accurately inputs and maintains a contact database.
- Maintains current knowledge of state and federal regulatory requirements, for clinic and plan operations and analyzes and interprets government program criteria.
- Communicates effectively with elderly individuals and state and government personnel.
- Educate members on the State eligibility process and keeping their certification current.
- Documents information accurately and descriptively and properly disposes of cases.
- Responds to incoming phone calls in a prompt, pleasant and professional manner utilizing WellMed phone etiquette and identifies self by correct name and title. Adheres to telephonic scripts.
- Maintains customer and organization confidentiality at all times.
Performs all other related duties as assigned.
Minimum Required Education, Experience & Skills:
2 years min of customer Service.
1 year of experience working in a corporate office environment.
Bilingual (English/Spanish) language proficiency.
Excellent written and verbal communications skills.
Working knowledge of Microsoft Office programs and data entry skills.
- High school diploma, GED or equivalent years of work experience
- 2+ years of customer service experience OR experience in a medical office, health care, call-center or office setting analyzing and
- solving customer problems
- Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
- Demonstrated ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner
- Proficient in translating health care-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
- Proficient conflict management skills including the ability to resolve stressful situations
- Prior health care experience
- Knowledge of billing/finance and eligibility processes, practices and concepts
- Associate’s Degree in related field preferred.
- More than one year of experience with adult Medicaid programs and CMS guidelines.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.