Outreach Counselor - Waco

Essential Duties and Responsibilities:

- Interface with clients and refer complaints or inquiries to appropriate departments, agencies, advocates, or client representatives.

- Stay updated on managed care relevant to supported client programs.

- Adhere to processing guidelines, protocols, and contract requirements for complaint processing and handling PHI/PII.

- Assist consumers in health plan enrollment, disenrollment, and transfers when necessary.

- Fulfill assigned duties directed by the Complaint Unit Supervisor or Project Management.

- Meet performance standards outlined in the annual criteria and bonus template for the position.

- Address complex customer service inquiries and problems over the telephone, noting consistent issues for resolution.

- Potentially respond to email inquiries.

- Prioritize customer service as the primary function, handling non-routine calls requiring deviation from standard procedures.

- Manage situations needing adapted responses or extensive research based on customer needs.

- Utilize computerized systems for tracking, information gathering, and troubleshooting.

- Handle escalated or unresolved calls from less experienced representatives.

- Tackle moderately difficult assignments, exercising judgment in issue resolution and recommending solutions.

- Conducts outreach, including phone calls, home visits, and community presentations in the field in accordance with project policy and procedures (50% of the time).

Solely responsible for a specific geographic area and related tasks for that area.

Travels independently using proper safety precautions.

- Conducts one-on-one and group outreach presentations to recipients and community members within a specific territory or initiative.

The work environment varies and is mobile.

- Presents program education and enrollment options to recipients to encourage recipient action.

Presents managed care options to recipients and assists them in using their health care and dental plans and community resources as needed.

- Identifies, develops, builds, and maintains positive relationships with county staff, state agencies, and community/faith-based groups to enhance presence in the community.

- Retrieves, researches, and analyzes data from multiple databases to answer client concerns and completes direct data entry into designated internal automated systems in accordance with EB Project policies and procedures.

- Identifies issues, problem-solves, and escalates unresolved issues and concerns to management immediately and regularly.

- Establishes and maintains knowledge of the community and participates in community events, health fairs, and other activities as needed.

- Multi-tasks in several computer applications at once while holding a conversation with client.

-Responsible for documenting activity in automated systems and reporting outcomes on a daily/ weekly basis.

- Responsible for ensuring confidentiality of client information.

- Uses customer servi...