Member Services Representative

1 week ago

New York, New York, United States Amida Care Full time

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Member Services Representative. Compensation will be commensurate with experience.

Position Summary:

The Member Services Representative position supports the Member Services Departments goal and mission to deliver the highest level of customer service and support for members and providers in a call center setting. The Member Services Representative is responsible to answer and resolve high volume of member and provider inquires, concerning benefits, services, and claims. This role is also responsible for completing outbound campaigns for member outreach, education, onboarding of members and quality initiative projects.

Responsibilities:

  • Answer member and provider inquires and requests concerning plan benefits, claims and complaints.
  • Escalating complex and urgent member care needs to the appropriate Management or departments Transfer members to Amida Care's Partners for Services provided on behalf of Amida Care.
  • Navigate different systems and databases to resolve member's issues or concerns.
  • Document all conversations/touchpoints in the Amida Care system (Salesforce).
  • Meet Quality Assurance requirements and other call center key performance metrics.
  • Collect and document prospective members information the Amida Care system (Salesforce).
  • Conduct outbound calls for projects and member outreach follow-ups.
  • Confirm and update member contact information and demographic, such as address, phone numbers & Primary Care Provider etc.
  • Promote and educate members on plan benefits, services, programs, alerts, and reminders.
  • Conduct New Member Orientation as assigned.
  • 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.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

Amida Care requires that all candidates selected for employment must provide proof of full Covid-19 Vaccination upon acceptance of an offer of employment.

EDUCATION REQUIRED

  • High School Diploma or equivalency certificate.

EXPERIENCES AND/OR SKILLS REQUIRED

  • Minimum One (1) years' experience in Customer Service
  • Must be able to maintain strict confidentiality of sensitive member's information (HIPAA)
  • Proficiency in Microsoft Office (Word, Excel).
  • Strong verbal and written communication skills
  • Ability to sit for an extended period of time.
  • Ability to manage multiple tasks and work consistently in a fast-paced environment.

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