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Distribution Services Rep III

Company: Fallon Community Health Plan
Location: Worcester
Posted on: September 25, 2022

Job Description:

Distribution Services Rep III

US-MA-Worcester

Job ID: 6997
Type: Full Time
# of Openings: 1
Category: Distribution Services
Fallon Health - Corp HQ

Overview

About Fallon Health: Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation's top health plans, and is the only health plan in Massachusetts to have been awarded "Excellent" Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org. Brief Summary of Purpose: Assists with day-to-day operations of department, assuming responsibility in the absence of the Supervisor. Provides guidance and instruction and monitors the daily work for an assigned group to ensure operational business needs are meet and adherence to established policy and procedures. Works under the guidance of the supervisor and raises concerns to address resource Constraints, interpret policy, establish new procedures, and resolve conflicts. In addition, this role will perform the work of a Distribution Services Rep II as an individual contributor. Responsibilities

Job Responsibility:

  • Imaging, data management, analysis, and reporting
    • Ability to assist staff with the production of letters and monthly department metrics.
    • Assist with enrollment application batching
    • Assist with premium payment coding
    • Maintain Imaging folders
    • Retrieve images in Alchemy and return to the requestor the images utilizing e-mail.
    • Updating the excel spreadsheet with the daily retrieval counts.
    • Respond to e-mail / paper within the same day.
    • Place report numbers into excel sheet for scanned totals and rescanned totals. This should be done daily and should take no more than 20 minutes.
    • Printing out member request from both QNXT and Customer Service database on Avery labels.
    • Filling out member with correct material. Informing predestinated Customer Service rep for items on hold.
    • Updating binder with new material.
    • Order material before supplies run out.
    • Complete request same day they are received. All labels should take no longer than 2 hours to complete.
    • Making sure all letters are folded, postage charged back to correct department and spreadsheet is up to date.
    • Call for repairs and updating repair log when needed.
    • 100% accuracy.
    • Serves as subject matter resource for the team
      • Acts as a senior resource person/subject matter expert for team members in all areas of the work, including but not limited to: application of appropriate policy and procedures, etc.
      • Assists the team in resolving routine operational issues as they arise. Serves as second level escalation with internal and external customers as necessary to resolve issues.
      • Acts as a point of contact and resource for the team.
      • Assists with complex issues that fall within existing policy and procedures. Escalates to supervisor when appropriate.
      • Promotes use of established practices and procedures.
      • Sales & Customer Service Fulfillments
        • Printing out member request from both QNXT and Customer Service database on Avery labels.
        • Filling out member with correct material. Informing predestinated Customer Service rep for items on hold.
        • Updating binder with new material.
        • Order material before supplies run out.
        • Complete request same day they are received. All labels should take no longer than 2 hours to complete.
        • 100% accuracy.
        • Print out sales fulfillment request from Avenue.
        • Collate and fill orders has needed.
        • Update reports in excel.
        • Order supplies from Wilde as needed.
        • E-mail sales rep and sales admin assistant if unable to fulfill orders.
        • All orders must be filled, shipped, or delivered to P2 storage same day unless summary of benefits arrive too late in the day to print.
        • Look up benefit summaries, benefit codes and anniversary dates as needed to fill orders
        • Participates in training and developing team
          • Participates in the orientation of new staff.
          • Assists with training and mentoring staff on the application of policy and procedures, documentation requirements, best practices, escalation requirements, use of supporting systems/applications, time management skills, etc.
          • Provides feedback to the supervisor on team members' performance - achievement of goals and deliverables and assessment of competencies.

            Qualifications

            Education: High School Diploma required Licenses/Certifications: Valid Drivers License Experience:
            • Preferably 1 - 2 years of experience in insurance industry
            • Six months to one-year general office experience required
            • Ability to lift upwards of 50lbs.
            • Proficiency in MS Office software with the ability to generate spreadsheets and reports Fallon Health Vaccination Requirements: To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as "Remote" require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment. Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. PM16 PI191368387

Keywords: Fallon Community Health Plan, Worcester , Distribution Services Rep III, Other , Worcester, Massachusetts

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