ECS Coordinator III

Overview

Job Posting Title
: ECS Coordinator III

Agency
: 807 HEALTH CARE AUTHORITY

Supervisory Organization
:
Eligibility & Coverage Service

Location
: 4345 N Lincoln Blvd, Oklahoma City, OK 73105

Work Schedule
:
Monday – Friday;
Primary Hours 8:00 a.m. – 5:00 p.m.

Job Type
:
Regular

Compensation
: $24.711538 / hourly

Position Purpose

This position serves as a key resource for coordinating daily member service activities, ensuring efficient workflow, and acting on behalf of management when needed. This role provides comprehensive training, resolves complex inquiries and complaints, interprets and communicates Sooner Care policies and procedures, and identifies operational improvements. The specialist supports member enrollment, claims adjudication, and system problem resolution while ensuring compliance with Medicaid regulations and OHCA policies.

Through advanced problem-solving, relationship management, and customer service skills, the specialist enhances service delivery to members and stakeholders across the agency.

• Serves as team leader in planning and coordinating daily member services activities, acting on behalf of or in the absence of managers.
• Acts as a supervisor and assists in maintaining workflow during staff absences.
• Provides comprehensive training to staff, contractors, agency partners, and stakeholders on Sooner Care policies and procedures.
• Develops and implements training materials and represents OHCA in seminars, training forums, and conferences.
• Answers complex incoming telephone and written inquiries from members, vendors, and other stakeholders, requiring individual research and interpretation of federal and agency rules.
• Independently analyzes, investigates, and resolves complex inquiries and complaints from members in a timely manner.
• Assists with the development, interpretation, and communication of written policies and materials related to member inquiries.
• Keeps abreast of OHCA/Sooner Care policies and provides accurate interpretation to providers and members.
• Identifies potential operational and contractual issues, communicates, and resolves issues with members and participates in the formulation of procedures to resolve conflicts.
• Coordinates with appropriate departments to resolve system problems and develop timely solutions.
• Determines eligibility, verifies, and enters data, and resolves issues related to enrollment and premium payments.
• Processes enrollment, plan changes, and corrections to member enrollment data systems.
• Facilitates claims adjudication, capitation, and reconciliation, and processes electronic claims inquiries.
• Participates in the OHCA member call center, answering a wide variety of questions and resolving problems related to contract requirements, licensing, and electronic funds transfer.
• Provides member training and keeps updated on OHCA/Sooner Care policies to provide accurate information to stakeholders.
• Assists division leadership with special projects and the development of training materials.
• Monitors incoming calls, staffing availability, and call wait times, ensuring agents understand and comply with performance standards and policies.
• Identifies complex problem areas within MMIS and the telephone response system, making recommendations for overall improvements.
• Other duties as assigned.

This position requires in-depth knowledge of Medicaid policies, federal and state regulations, and program administration principles. Strong skills in communication, problem-solving, and relationship management are essential for resolving complex inquiries and coordinating across divisions. Key Korn Ferry competencies that align with this role include Optimizes Work Processes (ensuring efficiency and compliance in service delivery) and Customer Focus (addressing member needs while maintaining high service standards).

• 1 year of experience in clerical office work or as a customer services representative plus 3 years of experience in customer service, processing tax returns, bookkeeping or closely related work OR
• An equivalent combination of education and experience, substituting 30…