Lead Member Services Representative

1 day ago

Doral, Florida, United States SOLIS Health Plans Full time
About Solis Health Plans

Solis Health Plans is a dynamic and innovative Medicare Advantage company dedicated to providing exceptional benefits and services to our members. We're committed to delivering a more personal and connected healthcare experience, and we're seeking a passionate and dedicated individual to join our team as a Lead Member Services Representative.

Job Summary

We're looking for a seasoned customer service professional to lead our member services team. As a Lead Member Services Representative, you will be responsible for directing and overseeing team members, resolving customer inquiries and complaints, and developing programs and procedures to enhance productivity and performance.

Key Responsibilities
  • Train new employees on customer service policies, procedures, and best practices.
  • Organize and oversee the schedules and work of assigned staff.
  • Conduct timely and constructive performance evaluations.
  • Handle discipline and termination of employees in accordance with company policy.
  • Monitor and review calls and correspondence between representatives and customers.
  • Ensure representatives are informed about changes to company products and services.
  • Collect data and prepare reports on customer complaints and inquiries.
  • Prepare monthly reports summarizing the assigned customer service team's performance.
  • Identify opportunities to update or improve customer service procedures and make recommendations.
  • Assist callers with inquiries regarding coverage decisions, grievances, appeals, benefit interpretation, eligibility verification, and more.
  • Responsible for maintaining customer service levels within established parameters.
  • Knowledge of plans benefits, CMS, and company policies and procedures.
  • Comply with company policies and procedures and maintain confidentiality of customer medical records.
  • Ensure compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
  • Participate in meetings, trainings, and in-service education as required.
  • Interact with other departments about member issues or concerns.
Qualifications
  • Bachelor's degree preferred.
  • At least three years of customer service experience required.
  • Previous experience in a supervisory role preferred.
Performance Measurements
  • Monthly evaluations.
  • Compliance with Department Call Metrics/Company Regulations.
  • Attendance/Punctuality.
  • Safety and Security.
  • Quality of work.

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