Member Services Representative- Bilingual

Description:

As a member service representative you will be responsible for processing member complaints and identification card requests.

Responsibilities and duties:

Handles telephone, written, and in-person inquiries in a courteous, professional, thorough, and timely manner to assure member satisfaction.
Provides quality services effectively to increase the overall level of customer service and satisfaction as measured by CMS.
Identifies the differences between a Grievance, Appeal, or Coverage Decision and processes the request through the appropriate channels.
Identifies, handles, documents, and/or routes Utilization Management inquiries appropriately.
Records all inquiries and complaints.
Manages time effectively and prioritizes tasks to meet deadlines.
Is attentive to the caller's needs, and responds quickly, and competently to requests.
Complies with company policies and procedures and maintains confidentiality of customer medical records by state and federal laws.
Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
Assists customers, family members, and others with concern and empathy; respect them

Qualifications:

PREFERRED:

Minimum of High School diploma
2 years of call center, medical front desk or other healthcare industry experience
Excellent communication skills and attention to detail
REQUIRED - English & Spanish