Member Experience - Team Lead

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit Amida Care for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Member Experience - Team Lead. Compensation will be commensurate with experience.

Position Summary:

The Member Experience Team Lead provides operational support for the entire Member Experience functional areas (Member Services, enrollment/certification, Appeals and Grievances and Growth).

Responsibilities:

• Assist the Appeals and Grievance department in obtaining medical records from providers.
• Investigate claim information as needed for member inquiries and complaints.
• Ability to manage and navigate escalated situations.
• Outreach provides site locations to investigate and resolve member billing.
• Obtain Live Undetectable (LU) Quarterly rosters from Provider Services.
• Review data submitted by providers to ensure all necessary information is received for Live Undetectable pay out, make corrections as needed.
• Assist with Training and Job aids as required.
• Responsible for reviewing and updating policies as needed.
• Review claims and clinical data to resolve LU Member inquiries via Salesforce.
• Support the Member Services Assistant Team (MSA) with Salesforce work distribution.
• Support Member Services Team with Data Entry as needed.
• Participate in member outreach efforts needed to close gaps.
• Support partnership relationships virtually and on site as needed.
• Support departmental projects as needed.
• Perform other duties as assigned by management.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

EDUCATION REQUIRED

• High School Diploma or equivalent combination of education and relevant work experience required.

EXPERIENCES AND/OR SKILLS REQUIRED

• High School Diploma or equivalent combination of education and relevant work experience required.
• Minimum three (3) years' experience in a Medicaid Managed Care Health Plan.
• Experience working with CRM's and support systems.
• Bi-lingual English and Spanish strongly preferred.
• Experience with managing escalated situations timely.
• Demonstrate proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint) and Adobe.
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.
• Demonstrate ability to read and communicate effectively in English.