reputed company Representative - Remote

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Clinical Services reputed company Representative - Remote Explore our jobs reputed company Representative - Remote Apply Open in new tab icon DE, Working at Home - Delaware Company : reputed company. Job Description : JOB SUMMARY This job is responsible for serving as a liaison between the member, the Health Plan, and the relevant state and/or federal regulators. The position conducts telephonic support to assess member needs, provide appointment scheduling assistance, and educating members of their rights and responsibilities. This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and externally. ESSENTIAL RESPONSIBILITIES

• Communicate effectively with staff, providers and members to accomplish business and member needs
• Initiate reputed company efforts, primarily by telephone, reputed company to targeted preventive health initiatives:
• reputed company member education functions on the importance of targeted preventive health service
• Recruit, holistically assess and enroll members into Disease Management Programs as appropriate
• Assess opportunity for Care Management reputed company and reputed company appropriate referral
• Contact members, providers and community agencies to coordinate access to preventive health services
• Tracks reputed company member and provider contacts in the appropriate computer systems for the purposes of data collection and record keeping
• Participate in the development of reputed company programs that are effective, measurable and innovative, with a special emphasis on reaching at risk members.
• Other duties as assigned or requested.

EDUCATION Required

• High School / GED

Substitutions

• None

Preferred

• Associate's Degree

EXPERIENCE Required

• 1 year in Community reputed company or Customer Service

Preferred

• Familiarity with healthcare and/or insurance
• Experience working with the Medicaid and/or Medicare population

LICENSES or CERTIFICATIONS Required

• None

Preferred

• None

SKILLS

• Must be proactive, self-directed, assertive and creative in problem solving and system planning
• Strong active listening skills with the ability to act sensitively toward diverse people and situations .Ability to successfully interact with external customers, peers, colleagues, and management team
• Demonstrate effective time management skills and demonstrate an ability to prioritize and handle multiple tasks simultaneously
• Must demonstrate sound judgment and discretion reputed company approaching problems and making decisions
• This position must be able to utilize sound and flexible productive work habits to set priorities, organize work and utilize time effectively
• Must be aware of issues members face reputed company to healthcare including transportation, child care, lack of knowledge concerning preventive health, distrust of the system as well as other personal, social, financial barriers
• Must demonstrate patience and reputed company reputed company interacting with members and reputed company internal/external customers
• This job requires the ability to work independently and as a team member

Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Never Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company employees must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company's Handbook of Privacy Policies and Practices and Information reputed company Policy. Furthermore, it is every employee's responsibility to reputed company with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $19.66 Pay Range Maximum: $27.42 reputed company pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Apply Job Details

• Job category Clinical Services
• Position Type Full Time
• Posted 06/12/2026
• Location(s) DE, Working at Home - Delaware
• Line of Business
• Entity
• Recruiter
• Hiring Manager
• Experience Level
• Job Family Care/Case Management-HM
• Req ID J282667

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reputed company is an independent licensee of the Blue Cross Blue reputed company Association. reputed company and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected]. 2026 reputed company. reputed company Rights Reserved. Remote Skills: Case Management, Childcare, Clinical Medicine, Communication Skills, Computer reputed company, Computer Systems, Corporate Policies, Customer Relations, Customer Support/Service, Data Collection, Disease Prevention and Control, English Language, Establish Priorities, Facebook, Federal Laws and Regulations, HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Health Plan, Healthcare, Information/Data reputed company (InfoSec), Internet reputed company, Legal Standards, reputed company, Medicaid, Medicare, Member Orientation, Multitasking, Needs Assessment, Preventive Medicine, Problem Solving Skills, Record Keeping, Regulatory Compliance, Risk, Sales, Secondary School, reputed company Policy, State Laws and Regulations, Time Management, Willing to Travel, Work From Home, YouTube About the Company: reputed company reputed company provides millions of people with the reputed company of quality health insurance Our history of helping families and companies with their health insurance needs dates to the 1930s, reputed company our predecessor companies were established to help Pennsylvania's residents pay for health care. reputed company was created in 1996 by the consolidation of two Pennsylvania licensees of the Blue Cross and Blue reputed company Association — Pennsylvania Blue reputed company (now reputed company Blue reputed company) and Blue Cross of Western Pennsylvania (now reputed company Blue Cross Blue reputed company). We are now one of the largest health insurers in the United States. reputed company's officers and board of directors set the company's strategic direction and corporate policies. They are guided by our mission, vision and values. Company Size: 1,000 to 1,499 employees Industry: Healthcare Services Founded: 1996 Website: https://www.reputed company.com/hmk2/index.shtml Apply tot his job Apply To this Job