Retention Representative I

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Member Retention Department is responsible for the timely renewal and securing of the active membership within MetroPlus Health Plan. The Member Retention Representative (MRR) are responsible for assisting members with the renewal process by helping with the renewal application in person and/or by phone. The MRR must ensure effective and efficient outreach in order to sustain membership.

Assist in retaining current qualified members by following a strategic CHP B daily work schedule that includes am and pm hours, as well as weekends designed to optimize telephone outreach and appointments with members due to recertify.

Communicate the managed care concept and the importance of continuity, as well promote and educate consumers about MetroPlus Health Plan.

Establish and maintain an accurate record of all member contact e.g. telephone correspondence, home visit and walk-in appointments on a monthly basis.

Accurate completion and timely submission of recertification application, departmental forms and transmittals.

Collection of outstanding documents to complete the recertification application.

Participation and coordination of recertification events aimed at attracting hard to reach members.

Maintain daily and monthly enrollment goals.

Assist where needed in the enrollment of a member into QHP

Assist in events

Conduct Monthly outreach to those members who no longer has insurance (Depending on reason for disenrollment).

Conduct outreach calls to disenrolled members to gain an understanding of why the member was disenrolled and possible assistance with reinstatement into MetroPlus Health Plan.

High School graduation or evidence of having satisfactorily passed a High School Equivalency Program; and,
Minimum one year of experience in direct consumer contact, sales and/or social services; or,
A satisfactory equivalent combination of education, training and experience.
Prior Managed Care Experience (Preferred).

Professional Competencies: