Marshallese Member Service Representative II

Official Schedule after training:

9:00am - 5:30pm

Maintain knowledge of the Arkansas Medicaid program and provide effective and efficient customer service to Medicaid Members for Arkansas Medicaid Program or Premium assistance programs. Respond to and resolve grievances and complaints; provide accurate and up-to-date information; assist in resolving issues or concerns about healthcare coverage. Familiarize Members with enrollment in a qualified health plan using the ACCESS Arkansas portal; assign or change PCPs on request;

assist Members seeking dental care coordination services by providing dental benefit information, locating a dentist or specialist, scheduling appointments, arranging transportation, and helping eligible Medicaid Members change their assignment in managed‑care dental plans. Serve as a subject‑matter expert on assigned contract deliverables, document services rendered in the designated format and system, and provide required reporting. Support the organization’s mission, vision, and values through honesty, excellence, accountability, respect, and teamwork.

• Coordinate communication between the various components of the AR Medicaid program.
• Maintain comprehensive knowledge of specialty area, pertinent organizations, and the health‑care environment, including contract deliverables, policies, procedures, available resources, current research, reports, and trends.
• Resolve customer/client requests through research, referral, policy review, revision and development, documentation, and follow‑up in accordance with established policies and procedures.
• Communicate effectively with customers and/or recipients and develop working relationships as necessary to meet contract deliverables of the specialty area project.
• Act as a resource to internal and external customers for information pertaining to the specialty area focus.
• Collaborate with the Information Services department to coordinate system developments and customizations.
• Create and maintain reports/documents to track and report project information, and prepare ad‑hoc reports or statistics as directed.
• Monitor specific items within the focus area, provide recommendations/feedback to external customers for quality improvement, and follow through to ensure compliance of recommendations.
• Utilize knowledge in all other areas of Member Services to assist as needed with overall operations.
• Assist PASSE Members in changing their initial auto‑assignment to a PASSE entity, complete the update in the MMIS system, and document all PASSE correspondence using the JIRA ticketing system.
• Operate efficiently using the Contractor’s software: MMIS, CURAM, JIRA ticket system, and ANSWER.
• Meet daily quotas added to fulfill contract deliverables as needed.
• Adhere to formatting, content, and style guidelines, ensuring usability, accuracy, consistency, and quality.
• Communicate needs and requests to other team members as appropriate.
• Follow AFMC, state, and federal protocols regarding data confidentiality, security, and HIPAA compliance.
• Adhere to AFMC Quality Standards of Excellence.
• Perform additional duties as assigned.

• Intermediate computer skills (Excel, Word, PowerPoint, Outlook).
• Typing speed of 25 words per minute.
• Exceptional business English and spelling.
• Ability to maintain confidentiality.
• Strong oral and written communication skills.
• Creativity.
• Customer service orientation.
• Capacity to meet deadlines.
• Attention to detail.
• Flexibility.
• Ability to work collaboratively and independently to achieve goals.
• Initiative.
• Professional, positive relationships with staff, partners, customers, constituents, members, and the public.
• Multitasking capabilities.
• Prioritization skills.
• Strong organizational skills.
• Problem‑solving skills.
• Professionalism.
• Project management skills.
• Ability to read, interpret, and apply laws, rules, and regulations.
• Knowledge of quality improvement processes and techniques.
• Time‑management skills.
• Ability to work overtime as needed.

Mobility, reaching, bending, lifting, grasping, reading, writing, communicating with personnel, remaining calm under stress, and traveling as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions with or without reasonable accommodations.

High School Diploma (required).

Bilingual in English/Marshallese. Two (2) years’ experience within the healthcare arena, understanding of Medicaid guidelines, customer relations, and call‑center experience. Desirable: additional experience within the healthcare arena and understanding of Medicaid guidelines.

Reliable, high‑speed wireless internet service (Wi‑Fi). Upload speed of at least 5 Mbps required to support softphone functionality.