Bilingual Medicare, Member Service Representative
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About The Position
The Bilingual Medicare Member Service Representative at Vestra Miami is a full-time position that plays a crucial role in providing exceptional customer service to plan members and healthcare providers. This role involves responding to incoming calls and may also require initiating outgoing calls to assist members with their inquiries regarding benefits, resolving issues, and educating callers about their options. The representative will verify enrollment statuses, make necessary changes to records, and research and resolve any enrollment system rejections. Additionally, the representative will address a variety of enrollment questions and concerns that may be received via phone or mail. In this position, the representative will be responsible for receiving, distributing, and tracking all incoming enrollment applications and plan change requests. A key aspect of the role includes conducting quality reviews of enrollment applications and plan change requests received from beneficiaries, the Sales Department, and the Centers for Medicare and Medicaid Services (CMS). The representative will also perform necessary outreach and research to address any identified discrepancies. At the end of each day, the representative will reconcile processed enrollments, plan change requests, disenrollments, and cancellations, ensuring that all records are accurate and up to date. The role also involves processing voluntary disenrollment and cancellation requests, generating member communications within required timeframes, and conducting intermittent quality reviews. The representative will handle return mail, including scanning and researching invalid address information, as well as billing, collecting premiums, and reconciling payments. Notifying clients of any premium discrepancies through payment adjustment notices is also part of the job. The representative will screen all forms and data for paperwork received from the Sales team and thoroughly document inquiry outcomes for accurate tracking and analysis. Building and maintaining positive customer relations is essential, and the representative will coordinate with various functions within the company to ensure that customer requests and questions are handled appropriately and in a timely manner. Compliance with State and Federal regulations and guidelines, as well as enterprise policies and procedures regarding member privacy and confidentiality of protected health information (PHI) and personally identifiable information (PII), is a critical aspect of this role. The representative may also assist with various special projects as defined by the Membership Department Manager and will perform basic job functions with support from co-workers, specialists, and managers on more complex issues.
