Customer Service Representative

2 weeks ago


Orange, California, United States Astiva Health, Inc Full time
About Astiva Health, Inc.

Astiva Health, Inc. is a premier healthcare provider specializing in Medicare and HMO services. Our mission is to deliver comprehensive care tailored to the needs of our diverse community, prioritizing accessibility, affordability, and quality in all aspects of our services.

Job 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.

Key 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
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-task, time manage, and prioritize
  • Ability to document information while on the phone with the member
  • Ability to build rapport with members
  • Fluent in Spanish, Korean, Vietnamese, or Cantonese/Mandarin (verbal and written)
Benefits
  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off


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