Senior Member Service Representative

POSITION SUMMARY/RESPONSIBILITIES
Has comprehensive knowledge of STAR Kids and STAR+PLUS programs in order to serve as a liaison to members and providers regarding benefits and services, resolving member and provider issues, providing information regarding all aspects of the Special Health Care Needs (SHCN) call center, which includes STAR Kids and STAR+PLUS programs either by phone or in person.  Ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA)-related policies such as Abuse, Neglect and Exploitation (ANE), Fraud, Waste, and Abuse (FWA) in regard to all aspects of operations within Member Services. Staff designated at the primary to STAR Kids' hotline must answer 95% of STAR Kids calls. Maximum call duration limits are not imposed. Calls are of sufficient length to ensure adequate information is provided to the caller.

EDUCATION/EXPERIENCE
A minimum of two years' college-level work in business, healthcare administration or related courses is required or four (4) years' experience as a customer service representative.  A minimum of two (2) years of HMO experience is required.  Healthcare problem resolution and experience with special healthcare members is preferred.