Member Services Representative II

Job Description

Job Description

UNITE HERE HEALTH serves 200,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

The Spanish Bi-lingual Member Services Representative II is to be the face of the Fund, especially to members and to provide benefit, eligibility, claim and health care education, information, and issue resolution to this multi-cultural community. The Member Services Representative shares the UNITE HERE HEALTH message by encouraging the utilization of benefits according to plan benefits and best healthcare value, while optimizing the member’s service experience.

ESSENTIAL JOB FUNCTIONS AND DUTIES

• Serves as the main point of contact for the Fund’s members, unions, employers, providers, and vendors on benefit, claims and eligibility issues, education, and questions
• Receives and records telephone inquiries regarding plan benefits, claims and eligibility and backs up Member Services I and Reception positions for walk-in inquiries
• Performs telephonic enrollment functions and in-person outreach as needed
• Encourages members to take steps to get involved in programs to improve their health
• Recognizes and communicates issues to management including trends and anomalies
• Research benefit, eligibility and claim issues and initiates corrective action with relevant departments
• Maintains up-to-date knowledge of all systems and sources relating to plan benefits, processes, policies, etc. that will affect performance of daily tasks
• Seeks management assistance on issues unable to resolve in a timely manner
• Maintains awareness of work volumes and service levels

ESSENTIAL QUALIFICATIONS

• Spanish bi-lingual skill
• 1 ~ 2 years of direct experience minimum in a healthcare, insurance, union, or community engagement environment
• Working knowledge and experience in enrollment requirements and processes
• Experience in customer service duties in person and/or over the phone
• Experience in a call center
• Working knowledge in complex claims processes, complex self-pay processes including payment, vacation hours, and leave of absence application
• Associate’s degree in healthcare or related field or equivalent work experience required

Salary range for this position: Hourly $20.36 - $24.97. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday ~ Friday, 7.5 hours per day (37.5 hours per week) with potential for hybrid work-from-home arrangement.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

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