Member Services Representative

1 week ago


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

Solis Health Plans is a Medicare Advantage Company that provides innovative solutions for its members and providers. Our team is dedicated to delivering quality service and creating a personalized experience throughout the healthcare journey.

This is a Full-Time position that requires Bilingual skills in English and Spanish. The successful candidate will be responsible for providing exceptional customer service to our members via telephone, written, or in-person interactions.

Key Responsibilities:

  • Handle customer inquiries and concerns in a professional and timely manner.
  • Assist members with coverage decisions, grievances, appeals, benefit interpretation, and eligibility verification.
  • Provide information on plan benefits, CMS policies, and procedures.
  • Identify and document coverage determinations, grievances, and appeals.
  • Interact with other departments to resolve member issues or concerns.
  • Approach work with attention to detail, follow company scripts, and manage time effectively.
  • Comply with company policies, procedures, and maintain confidentiality of customer medical records.
  • Ensure compliance with HIPAA, OSHA, and other federal, state, and local regulations.

Requirements:

  • High School diploma or equivalent.
  • Minimum 1 year of healthcare experience, preferably with a plan.
  • Working knowledge of HIPAA regulations.
  • Excellent communication, interpersonal, and problem-solving skills.
  • Proficient knowledge of Microsoft Office.
  • Familiarity with healthcare laws, regulations, and standards.
  • Ability to work effectively independently and in a team environment.

What We Offer:

Solis Health Plans is committed to providing a supportive and collaborative work environment. We offer a Full Benefits Package, including medical, dental, vision, and a 401K plan with a 100% company match. Our company has experienced exponential growth, and we are looking for talented individuals to join our team.



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