OutreachRepresentative

## **Company :** Highmark Inc. ## **Job Description :** **JOB SUMMARY** This job is responsible for serving as a liaison between the member, the Health Plan, and the relevant state and/or federal regulators. The position conducts telephonic support to assess member needs, provide appointment scheduling assistance, and educating members of their rights and responsibilities. This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and externally. **ESSENTIAL RESPONSIBILITIES** * Communicate effectively with staff, providers and members to accomplish business and member needs * Initiate outreach efforts, primarily by telephone, related to targeted preventive health initiatives: * Perform member education functions on the importance of targeted preventive health service * Recruit, holistically assess and enroll members into Disease Management Programs as appropriate * Assess opportunity for Care Management intervention and make appropriate referral * Contact members, providers and community agencies to coordinate access to preventive health services * Tracks all member and provider contacts in the appropriate computer systems for the purposes of data collection and record keeping * Participate in the development of outreach programs that are effective, measurable and innovative, with a special emphasis on reaching at risk members. * Other duties as assigned or requested. **EDUCATION** **Required** * High School / GED **Substitutions** * None **Preferred** * Associate’s Degree **EXPERIENCE** **Required** * 1 year in Community Outreach or Customer Service **Preferred** * Familiarity with healthcare and/or insurance * Experience working with the Medicaid and/or Medicare population **LICENSES or CERTIFICATIONS** **Required** * None **Preferred** * None **SKILLS** * Must be proactive, self-directed, assertive and creative in problem solving and system planning * Strong active listenin