Member Support Specialist II

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. The Member Support Specialist will work as an integral part of the case management team to serve as a resource to members. The Specialist will work telephonically and in person to support members with complex psycho-social issues which create barriers to adherence with medical regimens and achievement of optimal health outcomes. (Examples may include activities such as assisting with arranging transportation, linking patients with community resources, etc.). Will assist with program development, and build effective member and provider relationships. Essential Responsibilities: In coordination with the member’s case manager, develop and implement goals and/or plans tailored to assist members in navigating the complexities of the healthcare system. Educate members on understanding and working within the parameters of their benefit structure. Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes by effectively utilizing their benefits. Identify community resources and make referrals to members as appropriate. Serve as liaison between members and providers/agencies. Identify members for coordination and case management services through a variety of methods, including claims data and reports. Screen requests to identify appropriate referrals to case management from multiple internal and external sources. Work collaboratively with the case management team to help facilitate case management process. Participate in case management/care coordination meetings. Ensure compliance with applicable state and federal regulations and guidelines in day-to-day activities, including maintaining HIPAA standards and confidentiality of protected health information. Ensure accurate and timely documentation. Assist members with referrals, scheduling appointments and ensuring transportation to medical appointments is available. Assist members with non-clinical needs for transitions and different phases of care. Manage mailing lists and outgoing mailings. Supporting Responsibilities: Assist with the development of departmental procedures, reports and projects. Assist care management to meet quality measures as outlined by government regulations. Enter and collate data: prepare reports as assigned. Participate in team, department, company, and community-related committees as requested. Make presentations to small groups. Actively participates in quality improvement initiatives. Meet department and company performance and attendance expectations. Perform other duties as assigned. Work Experience: A minimum of three years of experience in community services or healthcare agencies focused on coordination services required. Experience in health insurance and delivering group presentations preferred. Education, Certificates, Licenses: High school diploma or equivalent required. Knowledge: Medical terminology. Proficient in Microsoft Office, including Word, Excel, PowerPoint, Medical management software (e.g CaseTrakker Dynamo). Excellent verbal and written communication skills and is able to work independently as well as to work effectively on a team. Good working knowledge of how to access community resources and healthcare system. Competencies: Building Customer Loyalty Building Strategic Work Relationships Contributing to Team Success Planning and Organizing Continuous Improvement Adaptability Building Trust Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It's our 1,900 employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 600,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance February 1: University of Oregon Winter Career Fair, 12-4p at EMU Ballroom (1395 University St, Eugene OR 97403) February 21: Oregon State Winter Career Fair, 11a-3p at Career Center (725 Southwest 26th Street, Corvallis OR 97331) April 17: Oregon State Spring Career Fair, 11a-3p at Career Center (725 Southwest 26th Street, Corvallis OR 97331) PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2022 alone we had 421 internal promotions! Certified Age Friendly Employer, 2023 | Age Friendly Institute Top Workplace 2023 and 2022 for Idaho | Idaho Press Top Workplace 2023 and 2022 for Oregon and SW Washington | The Oregonian #4 Healthiest Employer of Oregon 2021 | Portland Business Journal Healthy Worksite 2021 | Design Coalition in Montana PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email HR@PacificSource.com.