Member Experience Representative, Bilingual (Spanish)

Workforce Opportunity Services•Houston, TX

23h•Onsite

About The Position

Workforce Opportunity Services is hiring a Member Experience Representative to support senior members covered by Medicare Advantage plans. The role provides customer service to members and, as needed, their physicians, providers, insurance brokers, family members, and caregivers. Interactions take place by phone, email and other written channels, and in person. Representatives also document and service members in company software systems while managing multiple tasks. The representative addresses questions and concerns about enrollment, claims, benefit interpretation, eligibility, referrals, authorizations, and other plan matters. The role involves explaining benefits and plan options, following up to resolve issues, coordinating with providers and other departments, and documenting interactions in accordance with department standards and applicable policies and regulations. The position is full-time, on-site in Houston, Texas, Monday through Friday, 9:00 a.m. to 6:00 p.m., with occasional travel for meetings and training. The stated pay range is $20.00–$22.00 per hour, plus benefits.

Requirements

Fluency in English and Vietnamese, as stated in the qualifications.
High school diploma or equivalent.
1 to 2 years of call center or related customer service experience.
1 to 2 years of experience with Medicare benefits, including Medicare Advantage plans.
Ability to remain calm in charged situations.
Data-entry and general computer skills.
Effective written and oral communication skills and a professional, pleasant telephone manner.
Ability to handle high call volume while providing excellent customer service, with a record of efficiency in a high-volume environment.
Ability to commute reliably to the on-site Houston, Texas location.

Nice To Haves

Experience in the healthcare, insurance, or pharmacy industry is highly desirable.

Responsibilities

Provide excellent customer service to members and other contacts.
Accurately explain benefits and plan options in person, by email, or by phone to members, family members, providers, and caregivers.
Clarify member issues, determine causes, identify resolutions, explain solutions, and follow up as needed.
Escalate member issues to management or other departments when required.
Meet or exceed departmental quality, productivity, schedule-adherence, and attendance standards.
Respond promptly to members, internal staff, and providers through phone, omnichannel, and in-person interactions about benefits, eligibility, referrals, claims, and other issues, following policies, procedures, and job aids.
Take ownership of issues and focus on solutions and options through resolution.
Improve member satisfaction by efficiently and accurately resolving questions, complaints, and issues, coordinating with providers and other departments as needed.
Participate in management-assigned member calling projects, such as membership retention.
Follow policies, procedures, and job aids to support efficient and compliant operations.
Suggest improvements and report workflow problems through proper channels.
Participate in staff meetings and training.
Follow applicable federal and state regulatory requirements and HIPAA requirements.
Document interactions by completing member forms and summarizing actions in the computer system in accordance with department standards.
Work with other departments as needed.
Meet attendance, schedule-adherence, and individual performance goals, including call quality.
Perform other duties as assigned.