Member Experience Representative (Bilingual Vietnamese or Chinese)

Job Description

Job Description

Description :

Verda Health Plan of Texas has a contract with the Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Member Experience Representative – Bilingual (Vietnamese or Chinese) to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc and we will support you all the way.

Position Overview

The Member Experience Representative (bilingual) is responsible for providing quality customer service by addressing member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals / authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls, or written questions as well as educating members, family, providers and caregivers regarding benefits and plan options of Verda Healthcare.

Job Description

• Provide quality customer service. Educates members, family, providers and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email or telephonically.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution. Escalates appropriate member issues to management or other departments as required.
• Consistently meets and / or exceeds the departmental standards, including quality, productivity, and adherence to schedule and attendance.
• Responds appropriately and in a timely fashion to member / internal staff / providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids. Takes ownership of the issue, focusing on providing solutions and options for members, as necessary through resolution of member issue.
• Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed.
• Participates in member calling projects as assigned by management to support the overall Verda Health Plan goal of membership retention.
• Follows policies and procedures and job aids to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
• Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Verda Health Plan operations, as documented in company policies and procedures. Follows all HIPAA requirements.
• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
• Proactively engages and collaborates with other departments as required.
• Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations.
• Achieves individual performance goals established for this position in call quality, attendance, schedule adherence, and individual performance goals relating to call center objectives.

Requirements :

Minimum Qualifications

Required : High School diploma or equivalent required.

Bilingual and fluent in English AND one of the following : Vietnamese or Chinese

1-2 years call center or related customer service experience required.

1-2 years of prior experience with Medica

re benefits, including Medicare Advantage Plans

Experience in the healthcare, insurance, or pharmacy industry is highly desirable.

Ability to maintain calm demeanor, including during charged situations.

Data entry and general computer skills required.

Effective communication (oral and written) skills. Professional / pleasant telephone manner required.

Professional / pleasant telephone manner required.

Ability to handle large call volume, while always providing excellent customer service

Demonstrated efficiency / effectiveness is an environment with a high call volume.

Professional Competencies

Integrity and Trust

Customer Focus

Functional / Technical Skills

Written / Oral Communications

Critical / Analytical Thinker

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type : Full-time

Benefits :

401(k)

Paid time off (vacation, holiday, sick leave)

Health insurance

Dental Insurance

Vision insurance

Life insurance

Schedule :

Full-time onsite (100% in-office)

Hours of operations : 9am – 6pm

Standard business hours Monday to Friday / weekends as needed

Occasional travel may be required for meetings and training sessions.

Ability to commute / relocate :

Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit / walk at a workstation in an office or cubicle setting. Must occasionally lift and / or move up to 25-50 pounds.

Other duties may be assigned in support of departmental goals.