Member Services Representative/Inside Sales

2 weeks ago

Miami, United States Solis Health Plans Full time
Job DescriptionJob Description

**Position is FULLY ONSITE Mon-Friday, Bilingual in Spanish or Creole is required**

Location: 9250 NW 36th St, Miami, FL 33178.


Solis offers competitive benefits including:

  • Health, Vision & Dental Insurance.
  • Paid Time Off.
  • Paid Holidays.
  • 401k Matching Program.
  • Paid Long Term Disability & Life Insurance policy.
  • Employee Appreciation Events.
  • Positive & Supportive Work Environment.


Position Summary

Solis Health Plans is looking for a Member Services Representative primarily responsible for providing quality, professional service to all members when calls are received through the Member Services Department via telephone, written or in-person in accordance with CMS guidelines. Additionally, this position will be responsible for closing member enrollment sales for incoming inquiry calls from prospects. This position will have an hourly rate and commission-based structure.


Essential Duties and Responsibilities

  • Handles telephone, written and in-person inquiries in a courteous, professional, thorough, and timely manner to assure member satisfaction.
  • Engage with potential member prospects over the phone and educates them on Solis Health Plans’ available benefits as per CMS guidelines.
  • Assists callers on inquiries regarding coverage decisions, grievances, appeals, benefit interpretation, eligibility verification, medical group/PCP, explanation of how the plan works and how to utilize services, assists with information regarding referrals or authorizations, member complaints, identification card requests.
  • Must Report to the Doral HQ.
  • Responsible for maintaining customer service levels (abandonment rate, speed of answer and service level) within established parameters.
  • Is knowledgeable on plans benefit, CMS and Plans policies and procedure.
  • Applies high level of subject matter knowledge to solve a variety of common business issues.
  • Provides quality services effectively to increase the overall level of customer service and satisfaction as measured by CMS.
  • Identifies the differences between a Grievance, Appeal or Coverage Decision and process the request through the appropriate channels.
  • Identify, handle, document and/or route Utilization Management inquiries appropriately.
  • Identify and document Coverage Determinations.
  • Documents all inquiries and complaints.
  • Interacts with other departments about member issues or concerns.
  • Approaches work in a meticulous and thorough manner, pays attention to detail and follows company scripts.
  • Manages time effectively and prioritizes tasks to meet deadlines.
  • Assists customers, family members and others with concern and empathy; respect their confidentiality and privacy and communicate with them in a courteous and respectful manner.
  • Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
  • Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
  • During AEP, October 1 through March 31st they are required to be a part of the weekend rotation.
  • Participates in meetings, trainings, and in-service education, as required.
  • Highly regulated environment.
  • Time frames to handle issues are in accordance with CMS time frames.
  • Interacts with members, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.


Qualifications & Education

  • Must obtain 240 Health License (within the first 2 months of hire)
  • Must past AHIP exam
  • Bilingual in Spanish or Creole is preferred.
  • Minimum of High School diploma or equivalent.
  • A minimum of 1 year’s healthcare experience is required, with a preference for plan experience.
  • Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations.
  • Excellent communication skills, attention to detail, ability to set priorities appropriately and meet strict deadlines and the ability to manage multiple tasks simultaneously is required.
  • Excellent listening, interpersonal, verbal, and written communication skills with individuals at all levels of the organization.
  • Excellent computer knowledge is required, including proficient knowledge of Microsoft Office.
  • Familiarity with healthcare laws, regulations, and standards.
  • Ability to compute basic arithmetic and work with numbers.
  • Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies.
  • Ability to work effectively independently, work with very little supervision and in a team environment.
  • Ability to read, analyze, and interpret technical procedures or governmental regulations.
  • Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
  • Ability to define problems, collect data, establish facts, and draw valid conclusions.
  • Strong decision-making and analytical skills.
  • Must be self-motivated, organized and have excellent prioritization skills.
  • Must be able to work well under stressful conditions.
  • Must be able to work in a fast-paced environment.
  • Fluency in English and Spanish.


Commission Pay Structure

After successfully closing a prospect membership sale, employee will receive commission payment as described below.

  • $100 on the first month of effective enrollment.
  • $75 on the second month of effective enrollment.
  • $75 on the third month of effective enrollment.

Member must remain enrolled to receive above noted commission.


What Set Us Apart

Join Solis Health Plans as a Member Services Representative/Inside Sales and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference

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