Job Details

Job Information

Health Plan Operations Specialist
AWM-6915-Health Plan Operations Specialist
14  USD  - Hourly
3 months

Other Information
United States of America

Job Description


Kforce has a partnered with a client in Austin, Texas (TX) who put people first every day and are currently seeking several Health Plan Operations Specialists. As Health Plan Operations Specialist, you will be assigned to one of five key areas within the Health Plan Service area. You'll be providing customer service to your patients and be collaborative and reliable, if this sounds like you, apply today!

Essential Functions: Member / Provider Services Programs:

  • Answer inbound calls to aid members, providers, and/or healthcare personnel regarding coordination of care, enrollment, benefits, or claims within defined business guidelines
  • Facilitate cross functional communication to all groups within Health Plan Service Operations
  • Confirm requests are fully resolved and all questions are answered, ensuring member satisfaction
  • Adhere to Medicare guidelines, if applicable

Treatment Surveillance Programs

  • Monitor real-time member treatments to identify, investigate and determine intervention opportunities
  • Maintain oversight of members until they return to routine care
  • Identify members discharged from the hospital to ensure timely follow up and continued support

Care Coordination Programs:

  • Engage in various outbound campaigns to educate members and healthcare teams in an effort to improve care
  • Using defined -trigger events,- initiate outbound communication to patient/family caregivers and/or other concerned parties to facilitate the coordination of care for patients assigned to the CNU
  • Collect, review and employ all pertinent information available from but not limited to related clinical systems, care management notes, vendor information, geographic mapping software, direct patient communication, communication with physician or other members of health care team
  • Report to clinical staff, the discovery of unreported medical or social conditions or changes at home that may lead to adverse outcomes and ensures that these are referred to



  • High School diploma or GED/equivalent required; Work toward and advanced degree preferred
  • 0 - 1 year's related experience
  • Previous successful problem-solving experience
  • Must have clear and persuasive patient communication skills
  • Prior call center experience a plus
  • Health insurance experience a plus
  • Prior medical office experience a plus
  • Excellent critical thinking skills
  • Excellent verbal and written communication skills
  • Successful short task project management
  • Familiar with Microsoft Office applications, and computer user interfaces
  • Must be organized and detail oriented with a strong bias for follow-up and problem resolution
  • Proven ability to be a team player

Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.


Kforce is a professional staffing services firm offering Technology and Finance & Accounting jobs with top employers nationwide. We specialize in providing contract, contract-to-hire and direct placement opportunities, with over 50 years of experience in the staffing industry. Kforce offers many consultants comprehensive benefits depending on employment status, including medical, dental, 401(K), life insurance and disability. Our vision is to be "the firm most respected by those we serve."

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Kforce is an award-winning professional staffing and solutions firm that provides strategic partnership in the areas of Technology and Finance & Accounting services.