Program Specialist I, Member Services

Program Specialist I, Member Services

Providing technical support acts as a liaison between regulatory agencies, community partners and health providers.

Position overview

• Provide technical support to ensure that eligibility files for are processed correctly in HPSM’s claims/eligibility system.
• Ensure timely and accurate participant and member eligibility processing.
• Collaboratively work with staff at several agencies, community partners and health providers.
• May function as primary point of contact for HPSM IT and outside agencies/vendors regarding technical eligibility issues.
• Maintain enrollment information and document participant demographic changes and communications in HPSM systems and/or other databases.
• Assists members to process Health Insurance Premium Payment (HIPP) requests.
• Ensure integrity of HPSM Claims/Eligibility system by reconciling member records.
• Monitor reports and process program disenrollment in a timely manner.
• Prepare activity reports as required.
• Monitor changes in member eligibility status and take appropriate action.
• May identify opportunities for system improvement and modification and work with IT on monthly member file audits.
• Professionally represent HPSM in internal and external meetings.
• Participate in the development and revision of departmental and program policies and procedures.

Secondary Functions:

• Perform other duties as assigned.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply. 

Education and experience

• Equivalent to a high school diploma or GED required.
• Two (2) to three (3) years’ experience performing customer service preferably in a health plan environment.
• Previous experience with databases required.

Knowledge of:

• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Health insurance programs preferred.
• Customer service principles and practices.

Ability to:

• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Communicate effectively, both verbally and in writing.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds.
• Perform problem research, use analytical skills, and effectively influence positive outcomes.
• Develop and maintain strong professional relationships with a diverse range of people.
• Utilize a personal computer, including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook).
• Bilingual skills are highly desired.

Salary and benefits

The starting salary range is $25.03 - $31.66 per hour, depending on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

It is HPSM's policy to provide equal employment opportunities for all applicants and employees.  HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law.  HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.