Job Details

Position Title: Personal Care Connector

Location: Remote

Duration: 3 Months

Schedule: Standard, 40 hrs/week

Job Purpose

The primary purpose of the job is to support the daily operations of Medicare Member Services through the Personal Service Program, integrated care management, and utilization management program interventions.

The Personal Care Connector (PCC) is a high-touch, highly effective service specialist responsible for delivering exceptional member and provider support in a contact center environment. The PCC effectively manages inbound and outbound calls from Members, Providers, and internal and external stakeholders.

This role involves handling routine daily calls in accordance with established metrics and performance requirements, identifying members with Care Gaps and HEDIS-related health conditions, and assisting members in accessing care through Plan benefits and community resources. The PCC directly supports Clinical staff and assigned local teams, provides problem resolution and educational materials to members, and implements strategies to improve healthcare adherence and reduce barriers to care.

Key Responsibilities

• Perform all inbound and outbound calls and transactions supporting Clinical staff and assigned local teams.
• Handle daily routine calls from Members and Providers in alignment with performance and quality metrics.
• Identify members with Care Gaps and HEDIS-related health conditions and assist them in accessing appropriate care.
• Provide members with problem resolution, educational materials, and support to improve healthcare adherence.
• Act as an interface and facilitator between members and provider offices.
• Professionally handle customer inquiries related to benefit eligibility and service-related issues.
• Gather, assess, and document customer information thoroughly and efficiently.
• Resolve customer issues through one-call resolution guidelines or appropriate escalation processes.
• Maintain accurate call documentation, disposition, and reporting as required.
• Meet or exceed company performance metrics, including phone availability, occupancy, attendance, call quality, documentation, routing, and regulatory compliance.

• Working knowledge of Medicare and Medicaid (2-4 years preferred).
• One to Three Years of Experience Demonstrating the Following:
• Effective oral and written communication skills.
• Ability to document case notes while speaking on the phone with customers.
• Excellent customer service and interpersonal skills, both on the telephone and in person.
• Ability to handle multiple tasks simultaneously.
• Ability to act as an interface and facilitator between members and provider offices.
• Professional handling of incoming customer inquiries regarding benefit eligibility and customer issues.
• Effective telephone skills for inbound call triage and resolution.
• Effective outbound call skills to deliver educational messages, collect health data, and apply critical thinking to assess, triage, and offer solutions.
• Ability to thoroughly and efficiently gather customer information, assess needs, and educate customers on relevant products and services.
• Ability to utilize and navigate multiple systems simultaneously.
• Dependability with the ability to meet all attendance requirements.
• Ability to resolve customer issues using one-call resolution guidelines and/or escalated processes.
• Ability to meet or exceed company performance metrics, including availability, occupancy, attendance, call handling quality, documentation, routing, and adherence to regulatory compliance requirements.
• Ability to provide compliant solutions while maintaining service and operational objectives.
• Responsibility for call disposition and compiling and generating required reports.