Member Experience Representative

3 weeks ago

Huntington Beach, United States VERDA HEALTHCARE, INC. Full time
Job DescriptionJob Description 
Verda Healthcare, Inc. is hiring in California and in Texas We currently have a license with the Texas Department of Insurance (TDI) and a contract with the Center of Medicaid and Medicare Services (CMS) for a Medicare Advantage Prescription Drug (MAPD) plan to operate in January 2024.   We are looking for a Member Experience Representative – Bilingual (Vietnamese) to join our growing company with many internal opportunities. Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.  Align your career goals with Verda Healthcare, Inc and we will support you all the way. 
Position Overview
 
The Member Experience Representative is responsible for providing quality customer service by addressing member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls, or written questions as well as educating members, family, providers and caregivers regarding benefits and plan options of Verda Healthcare.   
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. 

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. Licensure And/or Certification Required 

·         CA Life, Accident, and Health license  Professional Competencies ·         Integrity and Trust ·         Customer Focus ·         Functional/Technical Skills ·         Written/Oral Communications ·         Critical/Analytical Thinker ·         Competitive goal oriented in Healthcare Sales
 

PHYSICAL DEMANDS 

· Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds. 

*Other duties may be assigned in support of departmental goals. 

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