Member Experience Representative

3 weeks ago

Houston, United States Verda Healthcare Full time

Company Description

VERDA Healthcare is a new Medicare Advantage Plan launched by a passionate, purpose-driven group of experienced healthcare professionals. The company is committed to providing easily accessible and equitable healthcare to people aged 65 and older in predominantly underserved, ethnic communities across the United States, with a focus on Asian-American, Hispanic-American, and Arab-American communities.


Role Description

This is a full-time on-site role for a Member Experience Representative at Verda Healthcare in Houston, TX. The Member Experience Representative will be responsible for daily interactions with Medicare-eligible individuals, providing exceptional customer service, assisting with plan enrollment, answering inquiries, resolving issues, and addressing concerns. The Member Experience Representative will also collaborate with internal teams to ensure a positive and seamless customer experience.


Job Description

  • Provide quality customer service. Educates members, family, providers and caregivers regarding benefits and plan options. 
  • Accurately explains benefits and plan options in person, via email or telephonically. 
  • Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.  
  • Consistently meets and/or exceeds the departmental standards, including, but not limited to quality, productivity, and adherence to schedule and attendance.
  • Responds appropriately and in a timely fashion to member/internal staff/providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids. Takes ownership of the issue, focusing on providing solutions and options for member, as necessary through resolution of member issue
  • Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed.
  • Participates in member calling projects as assigned by management to support the overall Verda Health Plan goal of membership retention.
  • Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
  • Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Verda Health Plan operations, as documented in company policies and procedures. Follows all HIPAA requirements.
  • Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
  • Proactively engages and collaborates with other departments as required.
  • Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations.
  • Achieves individual performance goals established for this position in the areas of, call quality, attendance, schedule adherence, and individual performance goals as it relates to call center objectives. 
  • Provides presentations in an educational manner to clients on the benefits and the enrollment/application process.
  • Ensures the privacy and security of Protected Health Information (PHI) as outlined in the Compliance Program.
  • Works closely with contracted providers and serves as the chief liaison between the health plan and contracted providers on marketing and sales-related issues.
  • Other duties as assigned to insure the continued growth and viability of Verda Healthcare.


Qualifications

  • Excellent communication and interpersonal skills
  • Customer service experience
  • Knowledge of Medicare and healthcare terminology
  • Strong problem-solving and decision-making abilities
  • Ability to navigate computer systems and use relevant software
  • Attention to detail and accuracy
  • Bilingual language skills (Spanish, Vietnamese, Chinese, or other relevant languages) are a plus
  • Prior experience in the healthcare or insurance industry is beneficial
  • Associate's or Bachelor's degree in a relevant field is preferred


Minimum Qualifications

  • Required: High School diploma or equivalent required. 
  • Bilingual and fluent in Korean, Vietnamese, Spanish   
  • 1-2 years call center or related customer service experience required. 
  • 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans  
  • Experience in the healthcare, insurance, or pharmacy industry high desirable.  
  • Ability to maintain calm demeanor at all times, including during highly charged situations. 
  • Data entry and general computer skills required. 
  • Effective communication (oral and written) skills. Professional /pleasant telephone manner required. 
  • Professional /pleasant telephone manner required. 
  • Ability to handle large call volume, while providing excellent customer service at all times 
  • Demonstrated efficiency/effectiveness is an environment with a high call volume.


Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Written/Oral Communications
  • Critical/Analytical Thinker
  • Competitive goal oriented in Healthcare Sales

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