Account Specialist

Healthfirst • United States, United States • 4w ago

Duties and Responsibilities:

Identifies potential members and designs a plan to educate potential members regarding the health benefits and care that istailored for the member as well as provide information regarding the particular plans features and benefits.

For existing members, will review current benefits to determine appropriate plan, assist with recertifying their existing coverageor suggest transfer to alternative plan that is better aligned for their care. Will provide guidance and assistance to recertify themembers healthcare coverage for Medicaid, CHP, EP and QHP, Medicare or Complete Care as well as adding on additionaleligible family members

Assist members with selecting high-quality Primary Care Physician (PCP), order member ID card and make monthly premium payment. This includes using the Healthfirst provider directory via the provider search tool, verifying the correct information in Salesforce/Member 360/OnContact/BizTalk before making any necessary changes based on members request.

Conduct group educational seminars /presentations including Healthfirst products and services as well as preventive care educations in person or virtually

Educate members about digital tools including HF mobile application, Twilio, as well as NowPow

Maintain and complete adequate Book of Business (BOB) for all encounters and leads on daily basis, while adhering to the BOB policies and procedures.

Identify and develop business opportunities within assigned territories

Conduct monthly group presentationstargetingsmall businesses and providers

Conduct monthly field outreach targeting pharmacies and supermarkets

Partner with Community Engagement to organize events within the sales territory, including but not limited to healthfairs, parades, holiday-themed events, trade show expos, hospital orientations, provider sponsored events as well as health relatedtheme events.

Establish and maintain relationships with local community organizations to promote HF benefits in the community

Assist DSE for follow up visits with providers to ensure plan visibilityand create leadsgeneration

Provide DSE feedback and follow up forprovider related issues and solutions

Assist DSE to conduct Provider portal orientation for new providers; educate the practice on how to navigate the provider portal (member eligibility, authorization, claim look up, membership roster, quality reports) to solidify the business relationship with providers and to support quality score improvement

Provide leads to DSE on new provider recruitment to diversify our network (FQHC, Dental, Pharmacy, Hospital, IPA,community providers)

Advance Healthfirst through superior customer service focused in an assigned territory, which will help optimize provider and member satisfaction

Raise any issues/ concerns to management relative to site coverage, competition, additional training needs and recommend process improvement and advise management of any proposed recommendations that can make a workflow or process more efficient.

Minimum Qualifications:

A Valid Drivers License

HS Diploma or GED equivalent

New York State Life Accident (optional) & Health License (Mandatory)

Experience in one of the following: sales, marketing, provider relations

3 years of sales experience (1 year in health insurance industry)

Knowledgeable and experience working with provider network/hospital

Bilingual

Excellent communication & interpersonal skills (Oral & Written)

Good computer skills & tech savvy (Microsoft Office)

Preferred Qualifications:

Bachelors Degree from an accredited institution

Account management experience

Medicaid and/or Medicare managed care experience

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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