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 supportneededtolive a healthy life that is free ofworry and full of joy. We are looking for a Member Experience Representative – Bilingual (Spanish, 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. Asan 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, benefitinterpretation, and referrals/authorizationsformedicalcare. Responsiblefor receiving, responding to, and directing member phone calls, or written questions as well as educating members,family,providersandcaregiversregarding 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.
- Providesfollow-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 membersatisfactionbyfollowingupandresolvingmemberissues,complaints, and questions in an efficient, timely and accurate fashion; coordinates resolution with providers and other departments as needed.
Member Experience Representative – Bilingual
- Participates in member calling projects as assigned by management to support the overall Verda Health Plan goal of membership retention.
- Followspoliciesand proceduresandjob aids to maintain efficient and complaint operations; communicatessuggestionsforimprovement and efficiencies to management; identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.
- Followsall 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.
- Documentstransactionsby completing applicable member forms and summarizing actions takenin appropriatecomputersystemand 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.
- Achievesindividualperformancegoalsestablishedforthis positionincall quality, attendance, schedule adherence, and individual performance goals relating to call center objectives.
Minimum Qualifications
- Required: High School diploma or equivalent required.
- Bilingual and fluent in English AND one of the following Vietnamese, Spanish, 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
Job Type: Full-time
Benefits:
- 401(k)
Member Experience Representative – Bilingual
- 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)
