Member Services Representative
1 week ago
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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