Health Program Representative I
Elevance Health

Be Part of an Extraordinary Team

Title: Health Program Representative I

Location: Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location: FL-MIAMI, 11430 NW 20TH ST, STE 300 or FL-TAMPA, 5411 SKY CENTER DR

Shift: Remote, Monday - Friday, 9:00am - 5:00pm

Build the Possibilities. Make an Extraordinary Impact.

The Health Program Representative I is responsible for providing initial contact between distinct Care Management programs and specific identified members. Under direct supervision handles inbound/outbound enrollment and engagement calls with eligible members to provide information regarding program features.

How you will make an impact:

Primary duties may include, but are not limited to:

• Educate members on the importance of HEDIS related Gaps in Care services.
• Helps with appointment scheduling, transportation, and promotes the incentive program. Addresses redetermination status with caller accordingly.
• Gathers and records appropriate member information in accordance with policies and procedures via telephone.
• Encourages members to participate in the Care Management programs by providing information about the program, outlining program features/value and explaining available services.
• Records call details and utilize call scripts as needed based on client requirements.
• Directs member inquiries to appropriate clinical staff. Initiates referrals and manages consults from clinicians for participants registered in Care Management.
• Gathers information from hospitals, health plans, physicians, patients, vendors and other referral sources.
• Contacts physician offices to obtain demographic information or related data as needed.

• Requires HS diploma or the equivalent and a minimum of 6 months experience in a telesales or customer service; or any combination of education and experience which would provide an equivalent background.

• HEDIS knowledge preferred.
• Computer/keyboarding proficiency strongly preferred.
• Healthcare experience preferred.
• Knowledge of Company products, services and benefits preferred.