SCAN

Customer Support

• Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services
• Ensures member satisfaction by providing superior customer service and willingness to help at all time while maintaining a professional demeanor
• Provides quality customer service by apply SCAN Five Service Principles
• Educates members, family, providers and caregivers regarding benefits and plan options
• Accurately explains benefits and plan options in person, via email or telephonically
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution
• Escalates appropriate member issues to management or other departments as required
• Consistently meets and/or exceeds the departmental standards, including, but not limited to: quality, productivity, and adherence to schedule and attendance
• Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids
• Takes ownership of the issue, focusing on providing solutions and options for members, as necessary through resolution of member issue
• Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed
• Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention
• Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Scan Health Plan operations, as documented in company policies and procedures
• Follows all HIPAA requirements
• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals
• Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development
• Contributes to team effort by accomplishing related results as needed

Customer Service Representative, Bilingual

Operations

• Patient engagement & access leadership
• Optimize, monitor, and actively manage the end-to-end patient engagement and access funnel
• Optimize coordination and workflows around referrals from risk-bearing entities (RBEs)
• Lead call center operations, ensuring strong performance management, effective workflows, and appropriate technology utilization
• Capacity planning & scheduling operations
• Optimize provider scheduling and routing logistics to balance provider capacity with patient demand
• Maximize provider utilization while sustaining patient and provider experience and satisfaction
• Work with the executive team to inform decisions around geographic expansion, hiring, provider compensation, and incentives
• Partner with Product and IT teams on scheduling technology improvements
• Support the Manager of Patient Engagement on escalated issues and capacity constraints
• Monitor and manage performance against service level agreements (SLAs)
• Oversee, coach, and lead account managers for key partners
• Monitor performance, report outcomes to partners, and drive mutual accountability on SLAs and contract performance
• Manage operational KPIs, including setting targets and holding teams accountable for performance
• Identify opportunities and lead process improvement initiatives
• Coordinate with the Clinical Operations Leader to manage provider capacity, performance expectations, and clinical workflows
• Support the President and VP of Commercial Strategy & Product Innovation to ensure a positive customer experience and optimized workflows
• Manage direct reports and provide coaching to support effective team leadership, goal-setting, feedback, and performance reviews

VP, Operations

Bilingual

• The Concierge Advocate serves as a direct point of contact for members’ questions and concerns
• He or she is responsible for taking member calls, as well as making proactive calls, as needed
• The Concierge Advocate is a liaison between the member and SCAN’s internal and external stakeholders, advocating for and representing the member as needed to resolve issues and concerns
• Front line contact center agent that is responsible for answering our member’s questions as they come in through inbound calls
• Manage and support a specific group of members
• Ensure that their members’ issues/questions/concerns are being addressed across the entire SCAN internal and external value chain with timely and effective resolution
• Drive SCAN’s Concierge customer service philosophy and ensure timely resolution of healthcare administrative issues/questions
• Assist the team leads in managing their membership
• Document interactions with members to update member’s records and help track issue resolution
• Participate in team huddles to discuss common member issues/trends and the path to resolution

Member Services Advocate – Bilingual

Clinical Operations

• Oversee and optimize daily operations within clinical pods
• Implement and maintain the infrastructure that supports daily POD operations
• Collaborate with central operations project teams to identify standardization opportunities
• Design, implement, and manage new healthcare initiatives and programs
• Monitor and analyze POD performance metrics
• Conduct regular touchpoints with the APC manager and Medical Director
• Perform in-person rounding at POD communities
• Recruit, on-board, manage, and coach the team supporting clinicians
• Develop, update, and audit POD operations workflows

Customer Service Representative, Bilingual

VP, Operations

Member Services Advocate – Bilingual

Manager, Clinical Operations