Member Experience Representative, Bilingual (Spanish)

Workforce Opportunity Services•Carrolton, TX

21h•Onsite

About The Position

Workforce Opportunity Services (WOS), a 501(c)(3) nonprofit, is hiring a Member Experience Representative to support senior members covered by Medicare Advantage plans. The role provides customer service through phone, email, other written channels, and in-person conversations. Representatives may also interact with physicians and other providers, insurance brokers, family members, and caregivers. They balance member interactions with documenting and servicing members in company software systems, requiring strong multitasking skills. The representative addresses inquiries and concerns about enrollment, claims, benefits, eligibility, referrals, and authorizations for medical care. The role involves explaining benefits and plan options, following up on issues through resolution, coordinating with providers and internal departments, documenting interactions, and meeting quality, productivity, attendance, and schedule-adherence standards. The position is full-time, on-site in Carrollton, Texas, Monday through Friday from 9:00 a.m. to 6:00 p.m., with occasional travel for meetings and training.

Requirements

Fluency in English and Vietnamese (the posting title specifies Spanish, while the qualifications specify 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 stay 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 location in Carrollton, Texas.
Ability to sit or walk regularly at a workstation in an office or cubicle setting.
Ability to occasionally lift or move 25 to 50 pounds.

Nice To Haves

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

Responsibilities

Provide excellent customer service to members.
Explain benefits and plan options accurately in person, by email, and by phone to members, family members, providers, and caregivers.
Follow up with members by clarifying issues, determining causes, identifying solutions, and explaining resolutions.
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 about benefits, eligibility, referrals, claims, and other issues through phone, omnichannel, and in-person interactions, following policies, procedures, and job aids.
Take ownership of issues and focus on solutions and options through resolution.
Improve member satisfaction by resolving issues, complaints, and questions efficiently and accurately, 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 appropriate 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 and schedule-adherence expectations and individual performance goals, including call quality and attendance.
Perform other duties as assigned.