Verda Healthcare
Member Experience Representative (bilingual Spanish)
Verda Healthcare, Houston, Texas, United States, 77246
Overview
Member Experience Representative – Bilingual Spanish at Verda Healthcare, Inc. Verda Health Plan of Texas has a contract with 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 support needed to live a healthy life that is free of worry and full of joy. We are looking for a
Member Experience Representative – Bilingual Spanish
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 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. Position Overview
The
Member Experience Representative (bilingual Spanish)
is responsible for providing quality customer service by addressing member inquiries in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls, or written questions as well as educating members, family, providers and caregivers regarding benefits and plan options of Verda Healthcare. This position reports to the Manager of Member Experience. Responsibilities
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. Provide 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 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 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 to maintain efficient and compliant 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 in call quality, attendance, schedule adherence, and other call center objectives. Qualifications
Required: High School diploma or equivalent. Bilingual and fluent in English and Spanish. 1-2 years call center or related customer service experience. Experience with Medicare Advantage Plans and medical benefits preferred. Healthcare, insurance, or pharmacy industry experience is desirable. Ability to stay calm in charged situations; strong data entry and general computer skills. Effective written and oral communication; professional telephone manner. Ability to handle large call volumes while providing excellent service. Professional Competencies
Integrity and Trust Customer Focus Functional/Technical Skills Written/Oral Communications Critical/Analytical Thinker Benefits
401(k) Paid time off (vacation, holiday, sick leave) Health, dental, vision, and life insurance Job Type & Schedule
Full-time, on-site Hours: 9am–6pm, Monday to Friday, with weekends as needed Occasional travel for meetings and training Ability to commute or relocate before starting Physical Demands
Regularly sit or walk in an office setting. May lift or move up to 25-50 pounds occasionally. Other duties may be assigned.
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Member Experience Representative – Bilingual Spanish at Verda Healthcare, Inc. Verda Health Plan of Texas has a contract with 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 support needed to live a healthy life that is free of worry and full of joy. We are looking for a
Member Experience Representative – Bilingual Spanish
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 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. Position Overview
The
Member Experience Representative (bilingual Spanish)
is responsible for providing quality customer service by addressing member inquiries in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls, or written questions as well as educating members, family, providers and caregivers regarding benefits and plan options of Verda Healthcare. This position reports to the Manager of Member Experience. Responsibilities
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. Provide 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 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 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 to maintain efficient and compliant 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 in call quality, attendance, schedule adherence, and other call center objectives. Qualifications
Required: High School diploma or equivalent. Bilingual and fluent in English and Spanish. 1-2 years call center or related customer service experience. Experience with Medicare Advantage Plans and medical benefits preferred. Healthcare, insurance, or pharmacy industry experience is desirable. Ability to stay calm in charged situations; strong data entry and general computer skills. Effective written and oral communication; professional telephone manner. Ability to handle large call volumes while providing excellent service. Professional Competencies
Integrity and Trust Customer Focus Functional/Technical Skills Written/Oral Communications Critical/Analytical Thinker Benefits
401(k) Paid time off (vacation, holiday, sick leave) Health, dental, vision, and life insurance Job Type & Schedule
Full-time, on-site Hours: 9am–6pm, Monday to Friday, with weekends as needed Occasional travel for meetings and training Ability to commute or relocate before starting Physical Demands
Regularly sit or walk in an office setting. May lift or move up to 25-50 pounds occasionally. Other duties may be assigned.
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