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

The Retention Representative is responsible for providing exceptional customer service and support to members enrolled in Medicaid STAR, STAR+PLUS, CHIP, CHIP-P, Health Insurance Marketplace, and D-SNP plans. Reporting directly to the Retention Manager, the Retention Representative will handle inbound and outbound calls, addressing member inquiries, resolving issues, and assisting with plan retention efforts. The representative will be a key player in ensuring member satisfaction and retention by delivering accurate information and maintaining a positive relationship with members.

Job Specicification and Core Competence

  • Participate in outbound call campaigns aimed at retaining at-risk members, providing necessary information, and ensuring they remain enrolled in their plans. Address and resolve member issues, concerns, and complaints in a timely and professional manner.
  • Answer inbound calls and respond to member inquiries regarding plan benefits, enrollment, and services across Medicaid STAR, STARPLUS, CHIP, CHIP-P, Health Insurance Marketplace, and D-SNP plans.
  • Provide accurate and clear information to members about their plans, benefits, and any changes that may affect them.
  • Work closely with the Retention Manager and other team members to escalate complex issues and ensure that member concerns are addressed appropriately.
  • Actively participate in training sessions and team meetings to improve service delivery and retention efforts.
  • Adhere to all company policies and procedures, as well as federal and state regulations governing all plans. Actively participate in training sessions and team meetings to improve service delivery and retention efforts.
  • Actively contributes to achievement of departmental goals, as identified in Department¿s annual business plan, including specific departmental process improvement plans, and other duties as assigned.


QUALIFICATIONS:

  • Education/Specialized Training/Licensure: High school diploma or equivalent required.
  • 2 years relevant work experience of which: 1 (one) year of health care / plan, or other related experience
  • Cross-functionality in Claims and Authorization Status, Benefits and Eligibility for at least two (2) lines of business for all Customer calls and/or electronic communication.
  • Previous experience in a healthcare or insurance call center environment preferred.
  • Other: Bilingual (English/Spanish) preferred.

Application Instructions

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