Outreach Counselor – Midland and surrounding counties NEW

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.

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 processincluding accessing job postings, completing assessments, or participating in interviews,please contact People Operations at [email protected].