About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Medicare Outreach Customer Service Representative, MI - Remote
We are looking for an Medcare Outreach Customer Service Representative, to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org.
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/.
Position Summary:
Responsible for delivering, strategizing, and improving quality with a focus on primary care. The position will educate and network with people of diverse backgrounds and cultures on products and programs to attract and retain membership in the Plan or attain Medicare Star measure goals as required. Establishes and maintains relationships for the promotion of healthy lifestyles among membership. Tracks and trends HEDIS or Medicare Stars rates. Responsible for member and provider contacts and positive outcomes. Foster the Plan’s presence in the community by interacting with members, providers, and outside agencies as assigned.
This position will support the Customer Service department Medicare Stars Program.
This Position is fully remote.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
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Qualifications:
Required:
- High School Diploma or equivalent educational certification.
- Two (2) years’ experience in a customer service-related position.
Preferred:
- Associate degree in health care administration, communication, marketing, or related field.
- One year experience in a community-focused outreach position.
- NCQA experience specific to HEDIS measurement.
- In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
