Member Services Representative - Bilingual

AMIDA CARE INC.•New York, NY

12d•$20 - $24

About The Position

The Bilingual Member Services Representative position is responsible and essential in providing customer service assistance to English and Spanish speaking members. This position will assist the Member Services management in the implementation, overall planning and day to day management of member outreach and support via the inbound/outbound call center in English and Spanish. These services include new member orientation and education; ongoing individual and group member education; provision of direct intervention to assist members to access services; facilitation of member retention efforts including CBO and CHOW outreach; development and provision of member materials; and a system to ensure receipt and documentation of all member complaints for follow up, investigation and resolution in English and Spanish. This position is also responsible for assisting, sharing, and reporting the Recertification /Retention process; this process includes conducting New Member Orientations (NMO) and member requests follow-up in monitoring, reviewing and assisting in any area concerning member retention, assisting with the coordination and completion of required recertification/retention outreach and inbound/outbound call center operations in English and Spanish.

Requirements

Must be able to maintain strict confidentiality of sensitive member’s information (HIPAA)
High School Diploma or equivalent combination of education and relevant work experience required
Minimum three (3) years’ experience in Customer Service
Must be able to speak and read both English and Spanish fluently
Demonstrate proficiency in Microsoft Office (Word, Excel, Access, Outlook, PowerPoint and Publisher) and Adobe
Demonstrate strong verbal and written communication skills
Demonstrate strong critical thinking and prioritization skill
Demonstrate ability to meet deadlines in a fast paced environment
Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts
Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values

Nice To Haves

Experience in Health Care Member Retention experience, preferred
Demonstrate experience with Medicaid and Medicare, preferred

Responsibilities

Receive inbound calls for HSNP lead line English and Spanish queues
Identify and resolve member’s inquiry by clarifying, researching and exploring answers and alternative solutions, and escalating unresolved problems
Remind members on their pending Care Alerts about getting the services like a PCP visit, STD testing, Viral Loads and Breast cancer screening, and etc.) and/or other Seasonal promotions (i.e. flu-shots)
Triage member’s concern and request for follow-ups with other departments of the Organization such as Pharmacy, Health Services, Care Coordination, RICU, Behavioral Health and Provider Services to assist members with any related concerns outside Member Services’ scopes
Utilize translation line for non-English/Spanish speaking members
Navigate different database and information warehouses to resolve member’s issues or concerns (i.e. ESI, CRM, ePACES, and Care Compass)
Contact and warm transfer members to Amida Care’s delegated entities (Davis Vision, Healthplex, and Beacon) for questions/concerns regarding vision, dental or behavioral health issue
Follow call script and guides in Spanish and English and document all conversations in the call center database and/or CRM system in a comprehensible way
Meet Quality Assurance requirements and other call center key performance metrics
Create lead and assist any perspective member with Medicaid transfer
Identify any discrepancies on member’s eligibility (active and/or inactive membership) via ePACES and coordinate with IT if members need to be disenrolled or enrolled in the Amida Care’s main tracking system
Make outbound calls for HSNP projects and conduct outreach follow–ups on After-Hour’s call log
Update PCP information, perform demographic changes and process request of ID Cards
Assist in filing and resolving member complaints
Track and conduct New Member Orientation (NMO) as assigned
Conduct special events outreach and update RSVP lists for member events
Conduct Panel Transfer as assigned
Participate in Peer Trainings
Assist with MSA (Member Service Assistants) assignments as needed
Attend events as needed: Town Hall Meetings, Live Your Life (LYL) Events, NML (New Member Luncheon)
Report all enrollment issues and/or trends to the Management
Participate in quality reviews and / or reports as requested
Participate and conduct test and / or analysis and provide feedback for improvement (i.e. CRM/Salesforce, Healthy Rewards Program, Pharmacy and Member Services queues, and etc.)
Perform other duties as assigned