Verda Healthcare, Inc. has a contract with the Center of Medicaid and Medicare Services (CMS) and Texas Department of Insurance (TDI) for a Medicare Advantage Prescription Drug (MAPD) plan for 2024. We are looking for a Member Experience Representative – Bilingual (English and Spanish/Vietnamese/Chinese/Korean) 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.
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, but not limited to 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 member, 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 in order 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 the areas of, call quality, attendance, schedule adherence, and individual performance goals as it relates to call center objectives.
- Perform additional responsibilities as designated.
Minimum Qualifications
- Required: High School diploma or equivalent required.
- Bilingual and fluent in Spanish, Vietnamese, Chinese, or Korean
- 1-2 years call center or related customer service experience required.
- 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans
- Experience in the healthcare, insurance, or pharmacy industry is highly desirable.
- Ability to maintain calm demeanor at all times, including during highly 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 providing excellent customer service at all times
- 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