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Astiva Health, Inc. is a leading 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 SummaryThe Member Service Specialist is a critical role within our organization, responsible for providing exceptional customer service to our members and providers. This position requires a high level of professionalism, attention to detail, and effective communication skills.
Key Responsibilities- Customer Service: Handle inbound and outbound calls, emails, and other necessary communications with members and providers to ensure customer satisfaction.
- Benefits Explanation: Clearly explain all details of the Medicare Advantage Plan, including procedures, protocols, benefits, and other necessary information to members and providers.
- Knowledge of Medicare Advantage: Fully understand all aspects of Medicare Advantage, including benefits, prior authorization, referrals, claims, enrollment, eligibility, appeals & grievances, providers networks, and pharmacy services.
- Documentation: Keep detailed written records of each telephone encounter during the call.
- Performance Metrics: Adhere to all call center metrics as set forth by CMS regulation and call center leadership.
- Issue Resolution: Attempt to resolve the member's issue completely during the first phone call.
- Education and Experience: 2+ years of customer service experience, minimum 1+ years' experience with Medicare Advantage, and health plan experience.
- Communication Skills: Excellent verbal and written communication skills, including active listening and probing techniques.
- Multi-Tasking: Ability to multi-task, time manage, and prioritize.
- Language Skills: Fluent in Spanish, Korean, Vietnamese, or Cantonese/Mandarin (verbal and written).
- 401(k)
- Dental Insurance
- Health Insurance
- Life Insurance
- Vision Insurance
- Paid Time Off
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