Position Purpose
Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines.
Education / Experience
Requires a High School diploma or GED. Requires 1–2 years of related experience.
License / Certification
For Florida-Sunshine Health Plan – All interactions with members are done telephonically.
Responsibilities
- Provides outreach to members via phone to support care plan next steps, community or health plan resources, and ongoing education for members and providers.
- Supports members by connecting them to other health plan and community resources to ensure high‑quality customer care/service.
- Applies working knowledge of assigned health plan activities and resources.
- Serves as front‑line support on member and/or provider inquiries, requests, or concerns, including explaining care plan procedures and protocols.
- Supports member onboarding and day‑to‑day administrative duties including sending welcome letters, related correspondence, and program educational materials.
- Documents and maintains non‑clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed.
- Knows existing benefits and resources locally and makes referrals to address Social Determinants of Health (SDOH) needs.
- Performs other duties as assigned.
- Ensures compliance with all policies and standards.
- Handles 47+ member calls per day with 100 % productivity.
- Participates in weekly productivity metrics and call quality evaluations.
Qualifications
- High School diploma or GED required.
- 1–2 years of healthcare or medical call center experience required.
- Experience in Medicaid or customer service in a call center required.
- Independent worker with strong communication and multitasking skills.
- Reliable internet connection required (work on hotspot if needed).
- Bilingual preferred.
- Must have Microsoft Office and computer skills.
- Must understand care management processes and be comfortable using cloud, classic, Excel, Teams, and Outlook.
EEO Statement
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of minority, gender, disability, religion, LGBTQI, age, or veterans.
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