Academy of Managed Care Pharmacy
Customer Outreach Advocate
Academy of Managed Care Pharmacy, Houston, Texas, United States, 77246
Community Health Choice, Inc. (Community) is a non‑profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 members with the following programs:
Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women
Children’s Health Insurance Program (CHIP) for the children of low‑income parents, including CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
Health Insurance Marketplace Plans offering individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre‑existing conditions
Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more
Improving members’ experiences is at the heart of every Community position. We strive every day to make sure that our members have access to the high‑quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high‑risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self‑sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Customer Outreach Advocate supports Community Health Choice campaigns that align with the operational needs of the organization. The role is responsible for handling non‑clinical inbound and outbound calls to our customers (members and providers), assisting members with renewing their health benefits by offering application assistance and other resources that help with the re‑enrollment process, and conducting outreach to improve member retention.
JOB SPECIFICATIONS AND CORE COMPETENCIES Essential Functions
25% Performs outreach calls to support member and provider campaigns for a wide variety of inquiries and assistance involving benefits, claims, medical appointments/transportation, and more
25% Educates, assists, and coordinates health services for members through effective communications on inbound and outbound calls
25% Completes ad‑hoc requests to ensure the safety of environment and well‑being of our membership in support of outreach affairs
10% Demonstrates effective telephone skills
15% Demonstrates effective customer service skills
Marginal Functions
Utilizes time effectively
Reports to Position Title: Customer Engagement Supervisor
MINIMUM QUALIFICATIONS
Education/Specialized Training/Licensure: High School diploma, GED, or equivalent
Work Experience (Years and Area): 3 years relevant work experience, including two years of experience in health care/plan, call center, customer service, and/or sales
Must have CHW certification or obtain it within the first six months of employment
Software Proficiencies: Microsoft Office (Word, Excel, Outlook)
COMPETENCIES Organizational Core Competencies
Customer Focus – Sustainability
Reliability and Dependability – Employee Empowerment
Honesty & Integrity – Sustainability
Achievement Orientation – Sustainability
Change Management – Affordability
Team Work – Employee Empowerment
Impact & Influence + Strategic Vision – Profitable Growth (Supervisory Employees)
People and Team Development – Employee Empowerment (Supervisory Employees)
Job Family / Job Title Competencies
Customer Oriented
Attention to Detail
Listening
Responding Sensitively
Writing / Composing
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Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women
Children’s Health Insurance Program (CHIP) for the children of low‑income parents, including CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
Health Insurance Marketplace Plans offering individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre‑existing conditions
Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more
Improving members’ experiences is at the heart of every Community position. We strive every day to make sure that our members have access to the high‑quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high‑risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self‑sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Customer Outreach Advocate supports Community Health Choice campaigns that align with the operational needs of the organization. The role is responsible for handling non‑clinical inbound and outbound calls to our customers (members and providers), assisting members with renewing their health benefits by offering application assistance and other resources that help with the re‑enrollment process, and conducting outreach to improve member retention.
JOB SPECIFICATIONS AND CORE COMPETENCIES Essential Functions
25% Performs outreach calls to support member and provider campaigns for a wide variety of inquiries and assistance involving benefits, claims, medical appointments/transportation, and more
25% Educates, assists, and coordinates health services for members through effective communications on inbound and outbound calls
25% Completes ad‑hoc requests to ensure the safety of environment and well‑being of our membership in support of outreach affairs
10% Demonstrates effective telephone skills
15% Demonstrates effective customer service skills
Marginal Functions
Utilizes time effectively
Reports to Position Title: Customer Engagement Supervisor
MINIMUM QUALIFICATIONS
Education/Specialized Training/Licensure: High School diploma, GED, or equivalent
Work Experience (Years and Area): 3 years relevant work experience, including two years of experience in health care/plan, call center, customer service, and/or sales
Must have CHW certification or obtain it within the first six months of employment
Software Proficiencies: Microsoft Office (Word, Excel, Outlook)
COMPETENCIES Organizational Core Competencies
Customer Focus – Sustainability
Reliability and Dependability – Employee Empowerment
Honesty & Integrity – Sustainability
Achievement Orientation – Sustainability
Change Management – Affordability
Team Work – Employee Empowerment
Impact & Influence + Strategic Vision – Profitable Growth (Supervisory Employees)
People and Team Development – Employee Empowerment (Supervisory Employees)
Job Family / Job Title Competencies
Customer Oriented
Attention to Detail
Listening
Responding Sensitively
Writing / Composing
#J-18808-Ljbffr