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QM Member Liaison Sr - West Des Moines, IA - PS1212 in West Des Moines, IA at Anthem, Inc.

Date Posted: 2/9/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

 

This is an exceptional opportunity to do innovative work that means more to you and those we serve. 

Location: West Des Moines, IA

Responsible for member retention by investigating and leading the resolution of member complaints. Serves as a liaison/mediator between member, provider and Plan.
 
Primary duties may include, but are not limited to:
  • Investigates, resolves, and documents member complaints in accordance with policies and state requirements.
  • Investigates and resolves issues regarding members with non-compliant, behavioral, and abusive conduct identified by providers.
  • Conducts member interviews to ensure that members are informed of their rights and responsibilities.
  • Assists member as needed, including locating a Primary Care Physician, obtaining medical records, transportation, and completing required forms.
  • Reviews complaint reports for accuracy and completeness and ensures required reports meet timely filing requirements.


Job Requirements

  • Requires a BA/BS in HealthCare or related field; 5 years of experience in a social or health related service-oriented industry; or any combination of education and experience, which would provide an equivalent background.