Offer summary

Qualifications:

High School Diploma or equivalent certification required., Two years of experience in a customer service-related position is necessary., Preferred qualifications include an Associate degree in health care administration or related field., Experience with HEDIS measurement and claims administration is a plus..

Key responsabilities:

Deliver and improve quality services with a focus on primary care.

Educate and network with diverse populations about health plans and programs.

Track and analyze HEDIS or Medicare Stars rates for performance improvement.

Foster community presence by engaging with members, providers, and agencies.

Job description

We are looking for an Medcare Outreach Customer Service Representative, to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org .

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/ .

Position Summary:

Responsible for delivering, strategizing, and improving quality with a focus on primary care. The position will educate and network with people of diverse backgrounds and cultures on products and programs to attract and retain membership in the Plan or attain Medicare Star measure goals as required. Establishes and maintains relationships for the promotion of healthy lifestyles among membership. Tracks and trends HEDIS or Medicare Stars rates. Responsible for member and provider contacts and positive outcomes. Foster the Plan’s presence in the community by interacting with members, providers, and outside agencies as assigned.

This position will support the Customer Service department Medicare Stars Program.

This Position is fully remote.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Qualifications:

Required:

High School Diploma or equivalent educational certification.
Two (2) years’ experience in a customer service-related position.

Preferred:

Associate degree in health care administration, communication, marketing, or related field.
One year experience in a community-focused outreach position.
NCQA experience specific to HEDIS measurement.
In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.

Additional Information