Member Services Representative
2 days ago
Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us
*Must be Bilingual in English and Spanish.*
Position is FULLY ON SITE Monday-Friday.
Location: 9250 NW 36th St, Miami, FL 33178.
Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match
Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to over 10,000 members
Join our winning Solis Team
Position Summary:
Solis Health Plans is looking for a Member Services Representative primarily responsible for providing quality, professional service to all customers when calls are received through the Member Services Department via telephone, written or in-person in accordance with Plan guidelines.
Essential Duties and Responsibilities:
- Handles telephone, written and in-person inquiries in a courteous, professional, thorough, and timely manner to assure member satisfaction.
- Assists callers on inquiries regarding coverage decisions, grievances, appeals, benefit interpretation, eligibility verification, medical group/PCP, explanation of how the plan works and how to utilize services, assists with information regarding referrals or authorizations, member complaints, identification card requests.
- Must Report to the Doral HQ.
- Responsible for maintaining customer service levels (abandonment rate, speed of answer and service level) within established parameters.
- Is knowledgeable on plans benefit, CMS and Plans policies and procedure.
- Applies high level of subject matter knowledge to solve a variety of common business issues.
- Provides quality services effectively to increase the overall level of customer service and satisfaction as measured by CMS.
- Identifies the differences between a Grievance, Appeal or Coverage Decision and process the request through the appropriate channels.
- Identify, handle, document and/or route Utilization Management inquiries appropriately
- Identify and document Coverage Determinations.
- Documents all inquiries and complaints.
- Interacts with other departments about member issues or concerns.
- Approaches work in a meticulous and thorough manner, pays attention to detail and follows company scripts.
- Manages time effectively and prioritizes tasks to meet deadlines.
- Assists customers, family members and others with concern and empathy; respect their confidentiality and privacy and communicate with them in a courteous and respectful manner.
- Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
- Ensures compliance with all HIPAA, OSHA, and other federal, state and local regulations.
- Participates in meetings, trainings and in-service education, as required.
- Highly regulated environment.
- Time frames to handle issues are in accordance with CMS time frames.
- Interacts with members, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.
- Minimum of High School diploma or equivalent.
- Minimum of 1year healthcare experience is required, with a preference for plan experience.
- Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations.
- Excellent communication skills, attention to detail, ability to set priorities appropriately and meet strict deadlines and the ability to manage multiple tasks simultaneously is required.
- Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization.
- Excellent computer knowledge is required, including proficient knowledge of Microsoft Office
- Familiarity with healthcare laws, regulations and standards.
- Ability to compute basic arithmetic and work with numbers.
- Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies.
- Ability to work effectively independently, work with very little supervision and in a team environment.
- Ability to read, analyze, and interpret technical procedures or governmental regulations.
- Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Strong decision-making, analytical skills.
- Must be self-motivated, organized and have excellent prioritization skills.
- Must be able to work well under stressful conditions.
- Must be able to work in a fast paced environment.
- Fluency in English and Spanish.
What set us apart:
Join Solis Health Plans as a Member Services Representative (Bilingual in Spanish) and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference
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