Member Services Representative - Bilingual
Overview
Bilingual Member Services Representative at AMIDA CARE INC. oversees member outreach and support through inbound/outbound call centers in English and Spanish. Responsible for member orientation education retention processes compliance and cross department collaboration while ensuring confidentiality.
What You'll Do18
- 1Receive inbound calls for HSNP lead line English and Spanish queues
- 2Identify and resolve member inquiries by clarifying researching answers and escalating unresolved problems
- 3Remind members on pending Care Alerts about services like PCP visits STD testing Viral Loads and Breast cancer screening seasonal promotions flu-shots
- 4Triage member concerns and request follow-ups with departments such as Pharmacy Health Services Care Coordination RICU Behavioral Health and Provider Services
- 5Utilize translation line for non-English Spanish speaking members
- 6Navigate databases and information warehouses to resolve member issues using ESI CRM ePACES and Care Compass
- 7Contact warm transfers to Davis Vision Healthplex and Beacon for vision dental and behavioral health questions
- 8Follow call scripts in Spanish and English documenting conversations in call center database
- 9Meet Quality Assurance requirements and call center KPIs
- 10Create leads and assist prospective members with Medicaid transfer
- 11Identify eligibility discrepancies via ePACES and coordinate with IT for system updates
- 12Make outbound calls for HSNP projects and conduct after-hour follow-ups
- 13Update PCP information perform demographic changes and process ID card requests
- 14Assist in filing and resolving member complaints
- 15Track and conduct New Member Orientation as assigned
- 16Conduct panel transfers participate in peer trainings attend events report enrollment issues to management
- 17Participate in quality reviews analyze CRM Salesforce Healthy Rewards Program pharmacy and member services queues
- 18Perform other duties as assigned
Requirements10
- 15+ years experience in customer service
- 2Fluent English and Spanish speaking
- 3High school diploma or equivalent combination of education and relevant work experience
- 4Minimum three years experience in healthcare member retention
- 5Proficiency with Medicaid Medicare systems
- 6Experience with Microsoft Office Adobe Creative Suite
- 7Strong verbal and written communication skills
- 8Critical thinking and prioritization abilities
- 9Ability to meet deadlines in fast paced environment
- 10Understanding of multicultural values beliefs and attitudes
Salary Insight
$42 - $50k per year
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