Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY:  

Responsible for identifying issues requiring special handling, working to satisfy the customer, following up for complete customer satisfaction.
Concierge Service Specialist (Medicare): Responsible for coordinating with business owners to meet escalated resolution turn-around times.  Emphasis is on Medicare and resolution of Grievances in accordance with CMS regulations.  Serves as a backup for regulatory complaints related to state and federal programs

MINIMUM QUALIFICATIONS:   

  • Education/Specialized Training/Licensure: Bachelors Degree in Business (BA), Social Work, or related field preferred. 
  • Work Experience (Years and Area): 5 years related experience in managed care, health care, or insurance field.
  • Software Operated: Microsoft Office (Word, Excel, Outlook), Salesforce, QNXT, JIVA and other managed care systems

SPECIAL REQUIREMENTS:   

  • Communication Skills: 
  • Exceptional Verbal (e.g., Public Speaking)
  • Bilingual Skills Required?   Yes    Languages: Spanish preferred. 
  • Writing /Composing        Correspondence   /  Reports
  • Other Skills:  Analytical,  MS Word
  • Work Schedule:     Flexible
  • Other Requirements: Exceptional Written Skills


RESPONSIBLE TO:  Director

EMPLOYEES SUPERVISED:  None

Application Instructions

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