Position Purpose: The Retention Specialist provides customer service to Health Choice members by initiating calls to greet new members, promote member relation with plan and collect member’s satisfaction information all while meeting monthly goals. Job duties include, but are not limited to:
- Adhere to HIPAA laws at all times; notify Privacy Officer immediately upon learning of a real or potential breach of protected health information.
- Achieve and maintain customer gratification during initial Welcome Call / New Member Survey
- Conducts dis-enrollment surveys to assess member’s satisfaction, and document any issues to improve existing customer satisfaction in efforts to retain membership.
- Complete/Request necessary forms such as HIPAA, Health Risk Assessment, Fraud Waste & Abuse, Grievance, Case Management, PCP Assignments, and various reports
- Ensure all initiated out-going member calls are documented/call-coded to track effectiveness and efficiency across the department in coordination with development of process improvement efforts in identified areas.
- Conduct quarterly Service Verifications calls to verify billed services were performed by the billing provider and received by the respective member
- Serve as back-up for Member Services Representative as necessary
Education / Experience / Other Requirements
Years of Experience: