Location: Field based in Prince William & Fairfax, VA County
The Community Health Care Caser Worker is responsible for serving as the initial and main point of Field contact between the Company and current and potential members.
How you will make an impact:
Responds to telephone, written, and in-person inquiries and initiates steps to assist regarding issues relating to content or interpretation of benefits, policies and procedures.
Provides timely and accurate resolution of inquiries and issues regarding benefits, services and policies.
Supports and promotes State Sponsored Programs through participation in community events.
Represents State Sponsored Programs in community collaborations.
Supports member access to care through home visits, processing of reports, and distribution of collateral materials.
Performs new member orientations.
Provides superior quality outcomes by taking ownership of issues to ensure timely resolution or follow-up.
Provides superior, professional, and courteous service to customers.
Comprehends the various cultural and linguistic needs of the Medicaid and SCHIP population, knowledge of the various health and social services available in the assigned region with a special emphasis on services offered by community based organizations, ability to work professionally with the company's associates, community-based organizations, providers and plan members.
Minimum Requirements:
Requires HS Diploma and a minimum of 1 year of customer service experience, or any combination of education and experience that would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
Understanding of the basic principles of managed care and the concepts of publicly financed health insurance such as Medicaid and SCHIP programs is preferred.
A Community Health Worker Certificate must be obtained in the first 6 months of employment in certain business units.
