Member Experience Representative, Bilingual (Vietnamese)

Workforce Opportunity Services•Carrolton, TX

4d•Onsite

About The Position

Workforce Opportunity Services (WOS) is a 501(c)(3) nonprofit that develops the skills of high-potential individuals and connects talent with organizations. This role supports members who are senior citizens covered by a Medicare Advantage plan. Representatives may also interact with physicians and providers, insurance brokers, and members’ caregivers. The work involves phone calls, email and other written channels, and in-person conversations, alongside documenting and servicing members in company software systems. The Member Experience Representative provides customer service by responding to inquiries and concerns about enrollment, claims, benefit interpretation, referrals, and authorizations for medical care. The representative answers and directs calls and written questions and educates members, families, providers, and caregivers about benefits and plan options. The position requires multitasking, issue ownership, and coordination with providers and other departments to resolve member needs accurately and efficiently. This is a full-time, on-site position in Carrollton, Texas, scheduled Monday through Friday from 9:00 a.m. to 6:00 p.m. Occasional travel for meetings and training is required. The pay range is $22.00–$25.00 per hour, plus benefits.

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 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 regularly sit or walk 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 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 calls, omnichannel interactions, and in-person discussions about benefits, eligibility, referrals, claims, and other issues, following policies, procedures, and job aids.
Take ownership of issues and focus on solutions and options for members 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 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, such as call quality and attendance.
Perform other duties as assigned.