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Senior Marketplace Member Liaison HICS

Company: Health Net, Inc.
Location: Little Rock
Posted on: December 4, 2019

Job Description:

Description: Position Purpose: Review, investigate, and resolve member inquiries regarding HICS in accordance with internal company guidelines and CMS standards Interact with members as needed to interpret HICS complaints and translate complex CMS standards into understandable rules and regulations for members Investigate member inquiries using multiple systems to identify and resolve root cause Write narratives to CMS and letters to members, in accordance with guidelines and standards, to explain findings and resolutions ensuring concerns are addressed Evaluate member feedback, analyze trends, and recommend workflows that may lead to policy or process improvements that support quality and performance standards Ensure compliance with State and Federal laws, following State and Federal guidelines as well as the procedures for the plans and the Corporation Work on complex cases and projects as needed for case resolution, job enrichment, CMS audit, etc Perform a quality review of cases before closing and uploading the case to CMS to ensure case has been fully worked and all systems are updated with correct information contained in narrative and all supporting systems Monitor open cases for turnaround times and coordinate with the team on making sure deadlines are being met and staying within standards

Keywords: Health Net, Inc., Little Rock , Senior Marketplace Member Liaison HICS, Other , Little Rock, Arkansas

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