Customer Service Representative

AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Member Engagement Representative This is a 100% remote position however candidates must reside in Miami Dade or Broward County.

First 90 days will be 100% onsite in our Doral office. Must be able to work a flexible schedule including weekends.

Job Scope : AvMed is committed to helping members become educated health care consumers. The Member Engagement Representative (MER) provides a high-quality level of customer service to plan members by answering complex benefit & enrollment questions, resolving issues, and providing education in a continuous call volume atmosphere.

MERs complete the intake of grievances and appeals as necessary ensuring that all concerns are responded to and resolved appropriately with first call resolution whenever possible.

MERs must maintain confidentiality according to regulatory requirements and are required to achieve a mastery level of knowledge and understanding of the entire suite of AvMed member plans.

If we have a choice to use the AvMed Job Scope use it and not the Sentara job scope.

Essential Job Functions :

Provides exceptional service to plan members via telephone by ensuring that appropriate actions are taken to answer inquiries and resolve problems / concerns in a timely and courteous manner.

Serves as the first point of contact for plan members and attempts to achieve First Call Resolution on each call, through communication and collaboration with internal departments.

Receives and professionally responds to member, agent, and broker inquiries both verbally and in writing. Inquires may include but are not limited to, processing policy changes, taking payments, enrollment discrepancies, billing questions, PCP changes and demographic updates.

Ensures all relevant information is obtained to handle inquiries and grievances using required resources. In addition, properly documents with relevant details, actions taken, resolution and properly categorizes member interactions in designated software applications.

Identifies and escalates priority issues reporting to department chain of command ensuring follow up to complicated customer calls when required.

Keeps the Commitment- by ensuring proper follow up and follow through is done with the member as committed to during the interaction.

Adheres to all regulatory requirements related to member confidentiality, case documentation, quality, and inquiry response times.

Masters productivity and quality standards according to individual and department goals. Focuses on achieving departmental and organizational objectives.

Performs additional duties and responsibilities as assigned by management

Minimum Requirements

HS Diploma / GED

Ability to work in a fast-paced contact center handling incoming calls pertaining to payment resolution and patient inquiries.

Must possess good listening skills and be able to communicate verbally with callers in a clear, concise, and professional manner.

A total of one year of experience across one or more of the following areas : healthcare setting billing or resolving insurance accounts receivable, adjudicating insurance claims, pre-registering or registering patients for healthcare services, handling inbound calls in a customer service call center, or providing customer service to the general public in a non-healthcare setting.

Preferred Requirements

Fast and accurate typing skills, 35 wpm minimum

Bilingual in Spanish

Excellent verbal and written communication skills

Strong interpersonal and rapport building skills

Strong customer service skills and professional phone voice

Ability to problem solve, troubleshoot, and resolve issues in a courteous manner

Ability to practice attentive and active listening

Ability to clearly and concisely summarize and document issues while talking to callers

Ability to multitask and manage several software applications at one time

Ability to function well under pressure while contributing to a supportive work team

Ability to comprehend medical terminology and knowledge of company products

Proficient with Microsoft computers applications

Basic knowledge of call center systems

Must be able to consistently meet or exceed the established metrics for this position

Must be able to comply with department and company policies and procedures including but not limited to attendance adherence and punctuality

Our Benefits :

As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers.

We offer a variety of amenities to our employees, including, but not limited to :

Medical, Dental, and Vision Insurance

Paid Annual Leave, Sick Leave

Flexible Spending Accounts

Retirement funds with matching contribution

Supplemental insurance policies, including legal, Life Insurance and AD&D among others

Work Perks program including discounted movie and theme park tickets among other great deals

Opportunities for further advancement within our organization

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace.

For information about our employee benefits, please visit : Benefits Sentara (sentaracareers.com)

Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

Note : Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind.

Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave.

Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

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