Essential Duties and Responsibilities
- Respond to complex customer, consumer, or stakeholder inquiries via telephone, email, in person interactions, or system based workflows, providing accurate and unbiased information regarding eligibility, enrollment, managed care, waiver programs, and supported services.
- Conduct intake activities and facilitate eligibility determination processes for applicants, including providing assistance from initial identification through enrollment or termination from the process.
- Present and explain program concepts, including waiver programs, managed care options, and participant rights and responsibilities.
- Assist consumers with application submission, data entry, and investigation of Medicaid eligibility as needed.
- Support consumers in selecting appropriate service options or coordinators while ensuring consumer choice and control are maintained.
- Manage and resolve complex or escalated enrollment, eligibility, complaint, or customer service cases in accordance with established procedures.
- Serve as a subject matter expert for internal escalations and special projects, utilizing specialized data sources, tools, and processes to complete assigned tasks.
- Research case history, compare documentation (including income or eligibility materials), and perform detailed analysis to verify accuracy and compliance.
- Conduct outbound contact, as needed, to obtain corrections, clarification, or supporting documentation required to resolve cases.
- Interface with internal teams, health plans, community partners, advocates, agencies, providers, and other stakeholders to coordinate resolution and support consumer needs.
- Foster and maintain effective working relationships with parties serving shared consumers, including physicians, assistance offices, providers, and care facilities.
- Identify stalled or problematic cases, provide additional attention or intervention, and escalate issues appropriately to ensure timely resolution.
- Track and document customer interactions, research activities, escalations, and outcomes in applicable systems.
- Anticipate recurring issues or trends and communicate findings to management for resolution or process improvement.
- Participate in special projects or initiatives as directed by supervisors or project leadership.
- Meet established productivity, quality, and performance standards as defined by program requirements.
- Maintain confidentiality and security of protected health and personal information in accordance with policy and contractual obligations.
- Perform other related duties as assigned by management.
- Conducts outreach, including phone calls, home visits, and community presentations in the field in accordance with project policy and procedures (50% of the time). Solely responsible for a specific geographic area and related tasks for that area. Travels independently using proper safety precautions.
- Conducts one-on-one and group outreach presentations to recipients and community members within a specific territory or initiative. The work environment varies and is mobile.
- Presents program education and enrollment options to recipients to encourage recipient action. Presents managed care options to recipients and assists them in using their health care and dental plans and community resources as needed.
- Identifies, develops, builds, and maintains positive relationships with county staff, state agencies, and community/fait h-based groups to enhance presence in the community.
- Retrieves, researches, and analyzes data from multiple databases to answer client concerns and completes direct data entry into designated internal automated systems in accordance with EB Project policies and procedures.
- Identifies issues, p roblem-solves, and escalates unresolved issues and concerns to management immediately and regularly.
- Establishes and maintains knowledge of the community and participates in community events, health fairs, and other activities as needed.
- Multi-tasks in several computer applications at once while holding a conversation with client.
- Responsible for documenting activity in automated systems and reporting outcomes on a daily/ weekly basis.
- Responsible for ensuring confidentialit y of client information.
- Uses customer service skills to adapt to situations and deal with clients face-to-face.
- Willingness to work a flexible schedule including weekends and evenings.
- Assists other Outreach Counselors and other team members with management and completion of daily duties to ensure compliance with contract standards and requirements.
- May be required to wear personal protective equipment (PPE) when having client in-person interaction for precautionary measures
- Provide customer service inbound support via telephone when needed to assist the EB Call Center department
- Performs other duties as may be assigned by management
Minimum Requirements
- High school diploma or GED required and 1+ years of relevant professional experience required, or equivalent combination of education and experience.
Program Specific Requirements:
- Bilingual fluency in Spanish preferred
- Required to travel within the region assigned
- High School diploma, GED, or equivalent certification
- DSHS Community Health Worker certification preferred.
- One year of human services experience or experience dealing with the public.
- Proficient in Microsoft Office products.
- Knowledge of Excel required.
- Ability to work with customers in a caring and respectful manner and with due understanding of and consideration for their unique circumstances.
- Excellent o rganizational, written, and verbal communication skills.
- Ability to perform comfortably in a fast-paced, deadline-orien ted work environment.
- Ability to work as a team member, as well as independently.
- Must be able to remain in a stationary position for an extended period of time.
- Occasionally lifts, carries, or otherwise moves items weighing up to 25 pounds.
- Work is often performed conducting home visits, presentations, and part in an office environment.
- Reliable transportation with proper insurance and a Texas Driver's License that meets the State of Texas requirements.
- Medicaid knowledge preferred
EEO Statement
Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.
Accommodations
Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at [email protected] .
Minimum Salary
$20.19
Maximum Salary
$23.00
