Member Experience Representative, Bilingual (Spanish)

Workforce Opportunity Services•Carrollton, TX

2d•$20 - $22•Onsite

About The Position

Workforce Opportunity Services (WOS), a 501(c)(3) nonprofit, develops the skills of high-potential individuals and connects talent with organizations. The Member Experience Representative works in a contact center supporting senior members covered by Medicare Advantage plans. The role may also involve interactions with physicians, providers, insurance brokers, and members’ caregivers. Communication takes place by phone, email, other written channels, and in person, alongside documenting and servicing members in company software systems. The representative delivers customer service by responding to questions and concerns about enrollment, claims, benefit interpretation, referrals, and medical-care authorizations. The role includes answering and directing calls and written questions, explaining benefits and plan options, following up to resolve issues, and documenting interactions in accordance with department standards and applicable policies and regulations.

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 location.
Ability to meet the listed physical demands: regularly sit or walk at a workstation and 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.
Explain benefits and plan options accurately to members, family members, providers, and caregivers by phone, email, or in person.
Follow up with members by clarifying issues, identifying their causes and resolutions, and explaining solutions.
Escalate member issues to management or other departments when required.
Meet or exceed departmental standards for quality, productivity, schedule adherence, and attendance.
Respond promptly to members, internal staff, and providers regarding benefits, eligibility, referrals, claims, and other issues through phone, omnichannel, and in-person interactions.
Take ownership of member issues and focus on solutions 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; 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.