Health Insurance Benefits Specialist, Community Engagement - Care N' Care Health Plan, Southwestern Health Resources (SWHR)

Education

• High School Diploma or equivalent required.

Experience

• Require 2 years extensive experience in Medicare Advantage Programs.
• Prefer 2 years high call volume handling experience in a Call Center environment.
• Prefer 2 years’ experience in Managed Care or Health Plan Operations.

• Prefer 2 years’ experience in Customer Service, Administrative Office, Account Management.
• Highly prefer Public Relations, Community Program Development, Community Event Coordination & Management experience.
• Experience with laws and regulations that affect services to elder people preferred.
• Bi-lingual in English/Spanish and/or English/Vietnamese highly preferred.

Licenses & Certifications

• Texas Life and Health License upon hire highly preferred.

Skills & Abilities

• Medicare experience preferable.
• Thorough knowledge of CMS guidelines, process, and systems.
• Excellent problem solving and organizational skills.
• Must have the ability to communicate in writing, speaking, and hearing in both in person and/or by telephone.
• Strong interpersonal communication skills.
• Ability to work independently or as a team.
• Excellent knowledge of Microsoft Office (Excel, Word, PowerPoint), Salesforce.

• Must be able to lift materials, carry and set up for events.

Position Responsibilities

The Benefit Specialist should have relevant customer service experience, preferably with Medicare experience and specifically with Medicare Advantage programs and familiar with PPO's and HMO's. Must have strong, oral, and written communication skills and planning and problem-solving skills. The Benefit Specialist will be able to answer questions from employees and community members regarding the plan benefits, research and resolve questions/issues while coordinating with other internal resources when needed. The Benefit Specialist will need to be able to break down complex topics.

Position Functions

• Responsible for checking Medicare guidelines and remaining current on any changes/coverage within benefits monthly/quarterly.
• Must demonstrate excellent understanding and execution The Customer Experience team processes and procedures. and identify and offer solutions to problems of reported trend in call types.
• Planning, developing, and communicating any changes with the plan benefits to the Customer Experience Team and internal departments as well as community members.
• Responsible for creating and maintaining call type reports and provide update to management.
• Collaborate with Quality and Control team to audit benefits training material/talking points weekly, monthly, or quarterly.
• Assure timely response to all member requests for services or assistance, providing direct response when resource help is not available.
• Assist with procedures, new programs and services as suggested by members and community as feasible.
• Attend a variety of community events on behalf of Care N’ Care.”
• Support the collaboratively with community partners to promote Care N’ Care in a positive and community-oriented way.
• Assists with ongoing assessment of the region’s health needs and resources, with particular emphasis on resources for senior wellbeing, empowerment, and independence for safe and vibrant aging.

Why Southwestern Health Resources 

As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Additional perks of being an SWHR employee:

• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org