Member Services Representative – Outbound

Amida Care is a Diversity, Equity, and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote, and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

The position of Member Services Representative – Outbound focuses on conducting outbound calls to Amida Care members based on different projects generated from Member Experience and Health Services departments. The objective of the Member Services Representative- Outbound is to outreach existing members to enroll into Amida Care programs such as the Live Your Life Undetectable Program, secure updated information from members regarding their PCP selections, correcting inaccurate required data identified by our Quality Team that requires a member touchpoint. This role will also be responsible for updating all newly acquired information into Team Connect/Salesforce which will assist all member-facing staff at Amida Care. This position will also be required to assist with the completion of New Member Orientation outbound calls.

Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.

• Make outbound calls and follow the call script developed for the campaign
• Identify and resolve member’s inquiry by clarifying, researching and exploring answers and alternative solutions, and escalating unresolved problems
• Document all conversations in the call center database and/or CRM system in a comprehensible way
• Remind members on their pending Care Alerts about getting the services like a PCP visit, STD testing, Viral Loads and Breast cancer screening, and etc.) and/or other Seasonal promotions (i.e. flu-shots)
• Triage member’s concern and request for follow-ups with other departments of the organization such as Pharmacy, Health Services, Care Coordination, RICU, Behavioral Health and Provider Services to assist members with any related concerns outside Member Services’ scopes
• Navigate different database and information warehouses to resolve member’s issues or concerns (i.e. ESI, CRM, ePACES, and Care Compass)
• Contact and warm transfer members to Amida Care’s delegated entities (Davis Vision, Healthplex, and Beacon) for questions/concerns regarding vision, dental or behavioral health Issue.
• Meet Quality Assurance requirements and other call center key performance metrics
• Create lead and assist any perspective member with Medicaid transfer
• Update PCP information, perform demographic changes and process request of ID Cards
• Assist in filing and resolving member complaints
• Must be able to maintain strict confidentiality of sensitive member’s information (HIPAA)
• Utilize translation line for non-English/Spanish speaking members
• Track and conduct New Member Orientation (NMO) as assigned
• Conduct special events outreach and update RSVP lists for member events
• Attend events as needed: Town Hall Meetings, Live Your Life (LYL) Events, NML (New Member Luncheon)
• Participate in Peer Trainings

Include other significant responsibilities needed to accomplish job purpose/goals that are performed on a daily or infrequent basis.

• Participate in quality reviews and / or reports as requested
• Participate and conduct test and / or analysis and provide feedback for improvement (i.e. CRM/Salesforce, Healthy Rewards Program, Pharmacy and Member Services queues, and etc.)
• Attend training sessions as required
• Perform other duties as assigned


• High School Diploma or equivalent combination of education and relevant work experience required; Bachelor’s Degree preferred.
• Three (3) years’ experience in Health Care; Member Retention experience preferred.
• Three (3) years’ experience in Member Outreach / Re-Certification Outreach.
• Demonstrate experience with Medicaid.
• Demonstrate proficiency in Microsoft Office (Word, Excel, Access, Outlook, PowerPoint and Publisher) and Adobe.
• Demonstrate strong verbal and written communication skills.
• Demonstrate strong critical thinking and prioritization skill.
• Demonstrate ability to meet deadlines in a fast paced environment.
• Strong phone skills that demonstrate adaptability to different personality types.
• Ability to multi-task, set priorities and manage time effectively
• Bi-lingual (English/Spanish) a plus.
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

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