Member Experience Representative (bilingual Spanish)

Job Description

Job Description

Description:

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. 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 health plan is looking for people like you 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 Health and we will support you all the way.

Why work for Verda and in this role?

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 changing the face of health care across the nation. 

This role is a contact center position to support our members who are senior citizens who used Verda for Medicare Advantage healthcare insurance coverage. In some cases, you may additionally interact with physicians/providers, insurance brokers, and members’ caregivers.

This is a challenging and rewarding position seeing that you are positively impacting our members who are seniors. Unlike a lot of contact center jobs which lack variety of activities, you have a lot of different calls, in person, and omnichannel (emails) interactions because there are so many scenarios that arise to service our members.  We are a customer service team within a mission-driven company.

Who are we looking for?

We are seeking a Member Experience Advocate – Bilingual (Spanish/English) and want people who value excellence, integrity, caring and innovation.  Candidate must have strong communication skills in English/Spanish, ability to problem-solve, and consistently demonstrate empathy, respect, and patience. 

Our team members balance interactions (phone, omnichannel, and in-person) and performing work in our software systems to document and service our members. This requires being able to multi-task to excel in the role.  

We are developing our Member Experience function as a center of excellence. This means our standard is excellence versus good or great.  We are seeking team members who are driven, hold themselves to a high standard of work, and desire to always improve with support and feedback from our team.

Position overview

The Member Experience Advocate (bilingual Spanish) is responsible for providing quality customer service by addressing member inquiries, questions and concerns 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. The role also will have some in-person interactions with our members.

Job Description

• Provide excellent customer service. 
• Accurately explains benefits and plan options in person, via email or telephonically. This includes educating members, family, providers and caregivers regarding plan benefits and options.
• Follow-up with members by clarifying the customer’s issue, determining the cause, identifying how to resolve situation, and explaining the solution. 
• Appropriately escalates 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.
• Respond appropriately and in a timely fashion to member/internal staff/providers by with phone calls, omnichannel interactions, and in-person discussions with members concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids. 
• Take ownership of an issue, focusing on providing solutions and options for members, as necessary through resolution of member’s issue/s.
• Increase member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion. Coordinate resolution with providers and other departments as-needed.
• Participate in member calling projects assigned by management to support the overall Verda Health Plan goal of membership retention or for other purposes.
• Follow policies and procedures and job aids to maintain efficient and complaint operations. Communicates suggestions for improvement and efficiencies to management. Identify and reports problems with workflows following proper departmental procedures. Actively participate in departmental staff meetings and training sessions.
• Follow all appropriate Federal and State regulatory requirements and guidelines applicable to Verda Health Plan operations, as documented in company policies and procedures. Follow all HIPAA requirements.
• Document interactions by completing applicable member forms and summarizing actions taken in applicable computer system and following standards set by the department or by other authorized individuals.
• Proactively engage and collaborate with other departments as required.
• Demonstrate personal responsibility and accountability by meeting attendance and schedule adherence expectations.
• Achieve individual performance goals established for this position such as call quality, attendance, schedule adherence, and individual performance goals relating to call center objectives.
• Other duties may be assigned in support of departmental goals.

Professional Competencies

· Integrity and Trust

· Customer Focus

· Functional/Technical Skills

· Written/Oral Communications

· Critical/Analytical Thinker

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time

Compensation Range: $21-25/hr

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance 
• Dental Insurance
• Vision insurance 
• Life insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

* Other duties may be assigned in support of departmental goals.

Requirements

• Required: High School diploma or equivalent required.
• Bilingual and fluent in English AND Spanish.
• 1-2 years call center or related customer service experience required.
• 1-2 years of prior experience with Medica.
• re benefits, including Medicare Advantage Plans.
• Experience in the healthcare, insurance, or pharmacy industry is highly desirable. 
• 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.
• 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.