Member Services Representative

Astiva Health•Orange, CA

48d

About The Position

About Us: Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: The Member Service Specialist is responsible for answering telephonic inquiries from current and potential members and providers regarding Medicare Advantage benefits, eligibility, enrollment, claims, referral, prior authorizations, appeals & grievances and other related concerns. Our Member Service Specialists ensure customer satisfaction by providing excellent customer service, displaying a desire to help and maintaining a professional demeanor. Member Service Specialists will be expected to maintain quality and performance standards.

Requirements

2+ years customer service experience
Minimum 1+ years’ experience with Medicare Advantage
Health Plan experience.
Excellent verbal and written communication skills including active listening and probing techniques.
Ability to multi-tasks, time manage and prioritize.
Ability to document information while on the phone with the member.
Ability to build rapport with members
Fluent in Spanish (verbal and written)

Responsibilities

Handle inbound and outbound phone calls, emails and other necessary communications with members and providers
Clearly identify and act on customer needs to achieve satisfaction.
Clearly explain all details of the Medicare Advantage Plan including procedures, protocols, benefits, and any other necessary information to the member or provider during inbound and outbound calls.
Fully understand all aspects of Medicare Advantage including but not limited to benefits, prior authorization, referrals, claims, enrollment, eligibility, appeals & grievances, providers networks and pharmacy services.
Provide accurate and complete information using the tools provided
Keep detailed written records of each telephone encounter during the call
Adhere to all call center metrics as set forth by CMS regulation and call center leadership.
Attempt to resolve the member’s issue completely during the first phone call.
Go above and beyond to provide exceptional customer service.