Job Description

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Member Support Specialist (Call Center Representative)

Location: Colorado (Must live in Colorado)
Schedule: Remote (periodic on-site meetings and trainings in Colorado Springs or Denver, CO)

The Member Support Specialist plays a vital role in connecting members and providers with health services, ensuring they can navigate and maximize their use of the health care system. This role requires strong customer service skills, empathy, and the ability to work independently in a fast-paced call center environment.

Essential Functions

• Serve as a liaison between Health First Colorado members, health systems, medical providers, and the CCHA Member Support Services call center.
• Answer member inquiries regarding eligibility, enrollment, and available services.
• Administer health needs assessments, identify barriers, present solutions, and triage members for higher levels of care coordination when needed.
• Provide support to physical and behavioral health providers by answering questions and connecting them with appropriate resources.
• Triage care coordination referrals, assessing urgency, documenting needs, and routing accordingly.
• Meet required inbound/outbound call performance and documentation standards.
• Build strong telephonic relationships with members by:
  • Educating them on the proper use of the health system
  • Referring to medical and non-medical resources
  • Completing timely follow-up calls
• Address member concerns and complaints in a professional, empathetic, and solutions-oriented manner.
• Always maintain HIPAA compliance and member confidentiality.
• Acts as the subject matter expert for Member Support Specialist initiatives to ensure best practices in outreach, engagement, and communication.
• Understands and effectively utilizes specialized resources, with working knowledge of local community programs, government, and social agencies, and conveys that knowledge to team members when appropriate.
• Develops strong relationships with members, including handling escalated cases and supporting high acuity/high intensity needs.
• Advocates on behalf of members with providers, specialists, and community agencies.
• Follows up with high acuity and high intensity members to ensure their needs are met.
• Effectively navigates systems to obtain the information needed for members.
• Provides feedback and recommendations to leadership regarding Member Support Specialist duties and functions.
• Identifies, develops, and utilizes community resources appropriately.
• Identifies opportunities for, and participates in, continuing education, including workshops, conferences, and relevant publications.
• Reliably consumes instructions from leadership, asks clarifying questions, and applies feedback to work performance.
• Promotes communication within the team to streamline roles and responsibilities.
• Participates in meetings and presents information as needed.
• Participate in team meetings, training sessions, and continuous skill development.
• Perform other duties as assigned.

Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills (Spanish preferred).
• Possess excellent customer service skills and ability to effectively interact with PHP personnel, medical and facility staff, other healthcare professionals, and the general public.
• Skilled in conflict management, problem prevention, and resolution.
• Precise and detail-oriented in managing, editing, and communicating information through spreadsheets and computer systems.
• Able to accept and work with diverse populations and provide culturally sensitive education and assistance to patients and families.
• Strong teamwork skills and ability to work independently when needed.
• Knowledge of medical terminology and social determinants of health.
• Strong organizational skills; able to multitask effectively in a high-volume call environment.
• Proficient in Microsoft Office Suite, EMR systems, and medical documentation.
• Self-motivated, reliable, and solutions focused.

Qualifications

• High School Diploma or GED required.
  • Additional certification or training as a medical assistant, receptionist, or technician is a plus.
• Minimum 1–2 years of experience in a healthcare setting.
• At least 1 year of experience with medical documentation (EMR).
• 1–3 years of experience in medical customer service.
• Experience working in a health care or call center setting strongly preferred.
• Bilingual (English/Spanish) strongly preferred.
• Demonstrated empathy and patience when assisting members, families, and providers.
• Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by company policies and procedures.
• Mobile device for work purposes as defined by company policies and procedures.

Salary Range:

$17.45 - $23.27 hourly