Medicare Outreach Agent Lead
Salary Range: $95,729 - $143,594
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.
FLSA Status: Exempt
Department: Medicare Outreach
Reports To: Director, Medicare Outreach
GENERAL DESCRIPTION OF POSITION
The Medicare Outreach Agent Lead executes SCFHP's Medicare outreach and enrollment operations to grow SCFHP Medicare enrollment in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements, and in support of organizational objectives.
ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.
- Execute sales and outreach strategy to maximize membership growth, including meeting Medicare enrollment goals as well as individual sales and performance goals.
- Assist with coaching and motivating sales team to meet sales, outreach and productivity goals.
- Ensure team is knowledgeable in all aspects of DualConnect product and relevant D-SNP and Medicare Advantage plan offerings.
- Answer questions related to Medicare sales and enrollment. Help create, maintain, and use operating instructions and tools needed to support department activities and to ensure compliance with all regulations.
- Research, identify, resolve, and respond to inquiries from beneficiaries, members, providers, community partners, and internal agents.
- Provide leadership of day-to-day activities for Medicare outreach agents. Make sure all outreach to disenrollment and deemed lists are completed accurately and timely.
- Provide input and support for implementation/upgrades/improvements of internal systems that support department processes; including but not limited to, identification of issues and opportunities for improvement, providing input to requirements, development of test plans and test cases, conducting testing, and reporting results and potential defects.
- Organize and conduct sales presentations in the community and assist eligible beneficiaries to enroll, including conducting a needs assessment to best explain product offerings.
- Make outbound calls to follow up and close business; receive and manage inbound enrollment calls, and emails from other departments.
- Manage and execute outreach plan to providers and community based organizations to support achievement of Medicare enrollment objectives.
- Seek opportunities to improve SCFHP image/visibility in the community. Contribute ideas to increase retention and enrollment.
- Develop, maintain, and use competitive analysis to inform outreach and retention efforts, including identifying and studying key competitors and their products, as well as related industry issues to maintain a personal awareness of competitive advantages and disadvantages; share the competitive analysis with the Marketing and Outreach teams.
- Stay current on SCFHP product and competing products; stay current on CMS Medicare Marketing Guidelines and with California specific guidance.
- Successfully complete SCFHP required product and certification training; maintain California Life, Accident and Health Insurance License.
- Identify issues and trends (data, systems, beneficiary, member, provider, other) as well as general departmental questions/concerns and report relevant information to management; make recommendations.
- Address member questions, concerns, grievances, appeals or requests for services in accordance with policies and procedures, including appropriate documentation and communication with other departments.
- Assist with new hire training by having new hires shadow use of sales, and operating systems, observe in the community, and listen to calls, in accordance with training guidelines and protocols. Observe new hires and provide feedback to Department Manager.
- Conduct routine quality monitoring, complete scorecard on a regular basis, and provide feedback to representatives.
- Assist with reviewing grievances and calls recordings.
- Attend and actively participate in daily, weekly, and monthly departmental meetings, training and coaching sessions.
- Perform other related duties as required or assigned.
REQUIREMENTS - Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
- Associate's Degree in a related field of study, or equivalent training/experience. (R)
- Minimum three years of Medicare sales, Medicare benefits advisory work, or Medi-Cal eligibility advisory work experience. (R)
- Two years of experience in a Medicare Outreach role at SCFHP (R)
- Strong presentation skills with intent to sell. (R)
- California Life, Accident and Health Insurance License, or the ability to obtain within 60 days of employment. (R)
- Self-directed with proven ability to assume responsibility, work independently, meet deadlines and prioritize with minimum supervision. (R)
- Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
- Experience with managed care and Medi-Cal. (D)
- Knowledge of current trends, practices, strategies, tools for outreach and sales, including customer relation management applications. (D)
- Ability to effectively coach, mentor and motivate team members. (R)
- Ability to establish and maintain effective working relationships with providers, community based organizations and program participants. (R)
- Bilingual in Spanish, Vietnamese, Mandarin or Cantonese. (R)
- Ability to work nights and/or weekends as needed. (R)
- Working knowledge of and the ability to efficiently operate all applicable computer software including a working knowledge of computer applications such as Outlook, Word and Excel. (R)
- Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
- Excellent communication skills including the ability to express oneself clearly and concisely when providing service to beneficiaries, SCFHP members, providers and outside entities in person, over the telephone, or in writing. (R)
- Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
- Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R)
- Ability to maintain confidentiality. (R)
- Ability to comply with all SCFHP policies and procedures. (R)
- Ability to perform the job safely with respect to others, to property, and to individual safety. (R)
WORKING CONDITIONS
Duties are performed away from the office in varied community settings, and also in an office environment while sitting or standing at a desk. Incumbent's responsibilities require frequent contact with beneficiaries, members and providers, as well as interaction with co-workers and managers, in person, by telephone, and via electronic communications. PHYSICAL REQUIREMENTS
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
- Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
- Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 20 pounds; (R)
- Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
- Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
- Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
- Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)
ENVIRONMENTAL CONDITIONS
Outside of the office - community settings, meeting rooms. In the office - general office conditions. May be exposed to moderate noise levels. EOE
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Santa Clara County Health Plan
Oct 19, 2024