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QM Member Liaison- IN (Lake, Tippecanoe, Jackson, Bartholomew, Monroe, Marion, Johnson, Virgo counties- REMOTE) PS23137 at Anthem, Inc.

Posted in Admin - Clerical 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Merrillville, Indiana





Job Description:

Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide.

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.


 

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

 

The QM Member Liaison is responsible for member retention by investigating and leading the resolution of member complaints. Serves as a liaison/mediator between member, provider and Plan.

  

Primary duties may include, but are not limited to:  


  • Conducts out-of office/home and community visits with members to educate and advise on programs, policy, and benefits. 

  • Investigates and resolves issues regarding members with non-compliant, behavioral, and abusive conduct identified by providers.

  • Conducts member interviews to ensure that members are informed of their rights and responsibilities.

  • Assists member as needed, including locating medical providers, accessing medical care, obtaining medical records, transportation, and community resources.

  • Represents members interests, including input into policy development, planning and decision making.

  • Develops and oversees the Member Advisory Committee and the Community Partner Advisory Committee.

  • Improves understanding of local organizations, philosophies, stakeholders, and providers that interact with or influence members.

  • Serves as an informal information resource, communication channel, complaint handler, facilitator, consultant, and practitioner for dispute resolution.

  • Brings issues to Plan leadership.

  • Serves as a liaison between member, provider and plan.

  • Provides education to community and member on Medicaid Managed Care.

  • Supports over all member outreach activities.

  • Develops relationships with community partners and community resources  

 


  •  Requires an AA/AS;

  • 3+ years of experience in a social or health related service-oriented industry;


  • or any combination of education and experience, which would provide an equivalent background.  

     

 This is a work at home position to be worked in one of the following locations:

Lake County

Tippecanoe County

Jackson County

Bartholomew County

Monroe County

Marion County

Johnson County

Vigo County

 

 Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com An Equal Opportunity Employer/Disability/Veteran