[Hiring] Retention & Eligibility Advisor @Martin’s Point Health Care

Role Description

The Retention & Eligibility Advisor is responsible for overseeing all aspects of the USFHP member retention program. This includes but is not limited to:

• Communicating with members to ensure they remain in the Plan.
• Identifying and tracking disenrollment reasons and trends to minimize dis-enrollments.
• Identifying and implementing member retention initiatives and strategies.
• Working cross-functionally across Martins Point USFHP and with members to increase loyalty and retain membership.
• Listening to member reasoning for disenrollment through multiple data points and providing leadership with recommended solutions.

Key Outcomes

• Develops and recommends policies and procedures regarding beneficiary issues with a focus on member satisfaction and retention.
• Uses disenrollment reports, complaint and grievance data, and member feedback to analyze disenrollment trends and apply critical thinking to resolve gaps.
• Coordinates outreach to pending disenrolling members.
• Collaborates with the Enrollment Department regarding issues involving the disenrollment of members of the Plan.
• Creates and presents member educational seminars and other presentations, as required.
• Supports training and quality initiatives.
• Offers insight about best practices to senior management based on disenrollment exit interviews with beneficiaries.
• Develops an aggressive retention strategy based on consumer feedback.
• Responsible for coordinating loyalty and retention programs designed to win back, reward, and retain members/beneficiaries.
• Acts as a liaison between member and health plan teams as needed.
• Collaborates with the member service escalation team to ensure member issues are addressed and resolved quickly.
• Writes and presents consumer behavior reports in the Consumer Relationship Management (CRM) database.
• Engages beneficiaries in fact-finding discussions to ascertain the reason for dissatisfaction.
• Processes all disenrollment requests in the CRM.
• Follows program policies and procedures consistent with Department of Defense, Defense Health Agency, and state laws and guidelines.
• Develops and maintains up-to-date disenrollment and retention reports monthly through collaboration with Business Intelligence (BI) analysts.
• Supplements outbound call volume when needed.

Qualifications

• Associate’s degree or equivalent combination of education and experience.
• 3+ years of experience with Tricare or USFHP.
• Experience working directly with health plan beneficiaries.

Requirements

• Deep knowledge of TRICARE benefit preferred.
• Understanding of managed care concepts.
• Excellent telephone and interpersonal skills required.
• Strong commitment to customer service required.
• Must be able to work efficiently and independently.
• Must be analytical in research and problem resolution.
• Strong computer skills (keyboard proficient, quick data entry, and a high level of accuracy).
• Able to work cooperatively with other departments.
• Multi-task oriented with the ability to prioritize.
• Well organized with excellent follow-up skills.
• Ability to handle crisis situations and can easily adapt to change.
• Ability to design work processes around customer needs and expectations.
• Ability to establish accountability.

Benefits

• Comprehensive benefits package including medical, dental, and vision.
• Retirement savings with employer contributions.
• Paid time off (including volunteer time off!).
• Additional employee benefits.

Pay Range

$28.37 - $35.05. The pay range above reflects the anticipated base pay range based on a full-time position. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-related considerations.