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Solis Health Plans · 3 days ago

Member Services Representative

Doral, FL, US

Full-time

Onsite

Entry Level

$18/hr - $20/hr

1+ years exp

Solis Health Plans is a new kind of Medicare Advantage Company that focuses on providing transparent and effective solutions for members and providers. The Member Services Representative is responsible for delivering quality service to customers through various communication channels, ensuring member satisfaction and compliance with company policies and regulations.

Health CareHealth DiagnosticsPersonal Health

Responsibilities

Handles telephone, written and in-person inquiries in a courteous, professional, thorough, and timely manner to assure member satisfaction

Assists callers on inquiries regarding coverage decisions, grievances, appeals, benefit interpretation, eligibility verification, medical group/PCP, explanation of how the plan works and how to utilize services, assists with information regarding referrals or authorizations, member complaints, identification card requests

Must Report to the Doral HQ

Responsible for maintaining customer service levels (abandonment rate, speed of answer and service level) within established parameters

Is knowledgeable on plans benefit, CMS and Plans policies and procedure

Applies high level of subject matter knowledge to solve a variety of common business issues

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 process the request through the appropriate channels

Identify, handle, document and/or route Utilization Management inquiries appropriately

Identify and document Coverage Determinations

Documents all inquiries and complaints

Interacts with other departments about member issues or concerns

Approaches work in a meticulous and thorough manner, pays attention to detail and follows company scripts

Manages time effectively and prioritizes tasks to meet deadlines

Assists customers, family members and others with concern and empathy; respect their confidentiality and privacy and communicate with them in a courteous and respectful manner

Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws

Ensures compliance with all HIPAA, OSHA, and other federal, state and local regulations

Participates in meetings, trainings and in-service education, as required

Highly regulated environment

Time frames to handle issues are in accordance with CMS time frames

Interacts with members, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances

Qualification

Healthcare experienceHIPAABilingual in EnglishSpanishMicrosoft Office proficiencyCommunication skillsAnalytical skillsAttention to detailInterpersonal skillsDecision-making skillsOrganizational skills

Required

Must be Bilingual in English and Spanish

Minimum of High School diploma or equivalent

Minimum of 1 year healthcare experience is required, with a preference for plan experience

Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations

Excellent communication skills, attention to detail, ability to set priorities appropriately and meet strict deadlines and the ability to manage multiple tasks simultaneously is required

Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization

Excellent computer knowledge is required, including proficient knowledge of Microsoft Office

Familiarity with healthcare laws, regulations and standards

Ability to compute basic arithmetic and work with numbers

Must be patient in dealing with an elderly population and sympathetic to hearing or vision deficiencies

Ability to work effectively independently, work with very little supervision and in a team environment

Ability to read, analyze, and interpret technical procedures or governmental regulations

Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public

Ability to define problems, collect data, establish facts, and draw valid conclusions

Strong decision-making, analytical skills

Must be self-motivated, organized and have excellent prioritization skills

Must be able to work well under stressful conditions

Must be able to work in a fast paced environment

Benefits

Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match!