Member Services Representative

About Solis Health Plans Solis Health Plans is a new kind of Medicare Advantage Company that provides transparent, effective solutions for members and providers. Our team of experts delivers quality service while fostering collaboration and support among colleagues. Location Position is fully on site, Monday‑Friday. 9250 NW 36th St, Miami, FL 33178. Benefits Full benefits package is offered on the first day of the month following hire, including medical, dental, vision, and a 401(k) plan with a 100% company match. Position Summary Member Services Representative—bilingual in English and Spanish—provides professional service to members through telephone, written, or in‑person inquiries, following Plan guidelines. Essential Duties and Responsibilities Handles telephone, written, and in‑person inquiries courteously, professionally, thoroughly, and timely to assure member satisfaction. Assists callers on coverage decisions, grievances, appeals, benefit interpretation, eligibility verification, medical group/PCP, plan usage explanations, utilization authorizations, member complaints, and identification card requests. Reports to the Doral HQ. Maintains customer service levels (abandonment rate, speed of answer, and service level) within established parameters. Applies knowledge of plan benefits, CMS policies, and procedures to solve common business issues. Provides quality services that increase overall customer satisfaction as measured by CMS. Identifies differences between grievances, appeals, and coverage decisions, processing requests through appropriate channels. Handles and documents utilization management inquiries appropriately. Documents coverage determinations and all inquiries and complaints. Interacts with other departments regarding member issues or concerns. Approaches work meticulously, follows company scripts, and pays attention to detail. Manages time effectively, prioritizes tasks, and meets deadlines. Assists customers, family members, and others with empathy, respecting confidentiality and privacy. Complies with company policies, procedures, HIPAA, OSHA, and other regulations. Participates in meetings, trainings, and in‑service education as required. Works in a highly regulated environment and adheres to CMS time frames. Interacts with members, family members, staff, visitors, government agencies under varied conditions and circumstances. Qualifications and Education High School diploma or equivalent. Minimum of one year of healthcare experience, preferably with plan experience. Knowledge of HIPAA regulations. Excellent communication skills, attention to detail, and ability to set priorities and meet strict deadlines. Proficient in Microsoft Office and basic arithmetic. Familiarity with healthcare laws, regulations, and standards. Patience with elderly populations and sensitivity to hearing or vision deficiencies. Ability to work independently with little supervision and in a team environment. Analytical skills, strong decision‑making, and problem‑solving ability. Self‑motivated, organized, and capable of working under stressful, fast-paced conditions. Fluency in English and Spanish. What Sets Us Apart As a bilingual Member Services Representative, you will join a focused team dedicated to serving our communities and delivering personal, supportive experiences for every member. #J-18808-Ljbffr