Member Experience Representative, Bilingual (Spanish)

Workforce Opportunity Services•Chandler, AZ

1d•Onsite

About The Position

Workforce Opportunity Services (WOS) is seeking a bilingual Member Experience Representative to support senior members covered by Medicare Advantage plans. The role is based in a contact center and involves assisting members, and sometimes their physicians and providers, insurance brokers, and caregivers. Interactions take place by phone, email and other written channels, and in person. Representatives also document and service member needs using company software systems. The representative provides customer service and education about enrollment, claims, benefits, plan options, eligibility, referrals, and authorizations for medical care. The role requires resolving member questions and concerns, coordinating with providers and internal departments, and documenting interactions in accordance with department standards and applicable policies, procedures, regulatory requirements, and HIPAA requirements.

Requirements

Fluent in English and Vietnamese.
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 volumes while providing excellent customer service, with a record of efficiency in a high-volume environment.
Ability to commute reliably to the on-site location in Chandler, Arizona.

Nice To Haves

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

Responsibilities

Provide excellent customer service.
Accurately explain benefits and plan options to members, family members, providers, and caregivers in person, by email, or by phone.
Follow up with members by clarifying issues, determining causes, identifying resolutions, and explaining solutions.
Escalate member issues to management or other departments as required.
Meet or exceed departmental standards for quality, productivity, schedule adherence, and attendance.
Respond promptly to members, internal staff, and providers through phone, omnichannel interactions, and in-person discussions about benefits, eligibility, referrals, claims, and other issues.
Take ownership of member issues and focus on solutions and options through resolution.
Improve member satisfaction by efficiently and accurately following up on and resolving issues, complaints, and questions, coordinating with providers and other departments as needed.
Participate in member-calling projects assigned by management, such as membership retention.
Follow policies, procedures, and job aids to support efficient and compliant operations.
Suggest improvements and report workflow problems through the 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 according to department standards.
Work with other departments as needed.
Meet attendance, schedule-adherence, and individual performance goals, including call quality and attendance.
Perform other duties as assigned.