Bilingual Member Services Representative

1 week ago

Huntington Beach, California, United States VERDA HEALTHCARE, INC. Full time
Position Overview

Verda Healthcare, Inc. is actively seeking a dedicated Bilingual Member Services Representative to enhance our customer service team. This role is essential in ensuring our members receive exceptional support and guidance regarding their healthcare options.

Key Responsibilities:

  • Deliver outstanding customer service by addressing inquiries and concerns related to enrollment, claims, benefits, and medical care authorizations.
  • Educate members, their families, and providers about the various benefits and plan options available through Verda Healthcare.
  • Provide clear explanations of benefits and options through various communication channels, including in-person, email, and phone.
  • Follow up with members to clarify issues, identify solutions, and ensure satisfaction.
  • Escalate complex member issues to appropriate management or departments as necessary.
  • Meet or exceed departmental performance standards, including quality, productivity, and attendance.
  • Respond promptly to inquiries from members, internal staff, and providers regarding benefits, eligibility, and claims.
  • Enhance member satisfaction by efficiently resolving complaints and questions.
  • Participate in member outreach initiatives to support retention goals.
  • Adhere to all federal and state regulations, including HIPAA requirements, to maintain compliance.
  • Document all member interactions accurately in the designated systems.
  • Collaborate with other departments to ensure seamless service delivery.
  • Maintain personal accountability by adhering to attendance and schedule expectations.
  • Conduct educational presentations on benefits and enrollment processes.
  • Serve as a liaison between the health plan and contracted providers on relevant issues.

Minimum Qualifications:

  • High School diploma or equivalent.
  • Bilingual proficiency in English and Vietnamese.
  • 1-2 years of experience in a call center or customer service role.
  • Familiarity with Medicare benefits, particularly Medicare Advantage Plans, is preferred.
  • Experience in the healthcare, insurance, or pharmacy sectors is highly desirable.
  • Ability to maintain composure in high-pressure situations.
  • Proficient in data entry and general computer skills.
  • Strong verbal and written communication skills with a professional demeanor.
  • Capacity to manage a high volume of calls while delivering excellent service.

Licensure and Certification:

  • California Life, Accident, and Health license required.

Professional Competencies:

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical Skills
  • Effective Communication
  • Analytical Thinking
  • Goal-Oriented in Healthcare Sales

Physical Demands:

Ability to sit or walk at a workstation in an office environment. Occasional lifting of up to 25-50 pounds may be required.

Other responsibilities may be assigned to support departmental objectives.

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