Customer Service Representative job - Public Consulting Group - Augusta, ME

Scope of Work : Member Services Representatives are expected to answer member calls, based on assignment, and take all appropriate follow-up actions, including, but not limited to, enrollment, MaineCare covered services, and EPSDT referral, etc. Responsibilities : Educate and enroll members into the MaineCare managed care program; Provide Member Services to MaineCare members; Provide members with a non-biased presentation of all current managed care options to promote the maximum freedom of choices within the member’s geographical region; Assist members by telephone with the completion of enrollment forms and related documentation by establishing and implementing a culturally and linguistically appropriate approach to member services; Answer member questions regarding available providers, language services and special programs within each managed care option (currently only one), refer enrollees to their respective HMO (not done currently) or managed care provider as appropriate; Access, read, and interpret member data elements and enter updates to reflect member activities, choices, and transactions in QNXT; Know and learn all functions and screens related to QNXT, Workflow and HealthPAS; Refer members to other state programs outside of the MaineCare Managed Care or fee-for-service plans such as the Division of Maternal and Child Health, WIC, etc.; Provide benefits for members under 21, by answering related phone calls; sort, file, and enter information into the QNXT system regarding benefits for members under 21; Report all problems to the appropriate supervisors and recommend solutions; Understand and be able to use all other automated systems, including, but not limited to, tracking all incoming/outgoing contacts in the QNXT call tracking system, etc.; Work as a team member with all other Member Services staff; Attend staff meetings and provide daily updates to the Member Services Supervisor or Team Lead on activities; Other duties as necessary. Minimum Qualifications : High school degree or GED and experience involving customer service relations; Call Center experience; Computer skills; Knowledge of Microsoft Office programs; Ability to communicate effectively; Ability to maintain confidentiality; Ability to multi task in a fast paced environment; Experience in meeting deadlines and adhering to strict standards; Enthusiasm for work responsibilities; Knowledge of MaineCare (Medicaid) is desirable; Knowledge of the cultural and geographic make-up of the State of Maine is desirable; and Knowledge of French, and/ or other languages is desirable. PCG is an EEO/AA/VEVRAA EMPLOYER