Verda Healthcare · 3 months ago
Member Experience Representative (bilingual Vietnamese)
West Sam Houston
Full-time
Onsite
Entry Level
1+ years expVerda Healthcare is committed to providing equitable access to healthcare services and is looking for a Member Experience Representative who is bilingual in Vietnamese. This role involves delivering quality customer service by addressing member inquiries related to enrollment, claims, benefits, and medical referrals while ensuring member satisfaction and compliance with regulations.
Insurance
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
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 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 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 call quality, attendance, schedule adherence, and individual performance goals relating to call center objectives
Qualification
Required
High School diploma or equivalent required
Bilingual and fluent in English AND Vietnamese
1-2 years call center or related customer service experience required
1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans
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
Ability to handle large call volume, while always providing excellent customer service
Demonstrated efficiency/effectiveness is an environment with a high call volume
Preferred
Experience in the healthcare, insurance, or pharmacy industry is highly desirable
Benefits
401(k)
Paid time off (vacation, holiday, sick leave)
Health insurance
Dental Insurance
Vision insurance
Life insurance
Company
Verda Healthcare
VERDA Healthcare is a new Medicare Advantage Plan launched by a passionate, purpose-driven group of experienced healthcare professionals committed to the idea that healthcare should be easily and equitably accessed by all.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
James Kim
Board Member, Co-Founder and Interim CMO
Thinh Tran, MD, MBA
Co-Founder and Board Member
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