Member Services Representative

Job Full Description Bilingual Healthcare Customer Service Representative We are seeking a bilingual Customer Service Representative to assist health plan members with questions regarding benefits, eligibility, coverage decisions, grievances, appeals, referrals and authorizations. Responsibilities: Respond to member inquiries by phone, in writing and in person Explain plan benefits, eligibility, coverage and how to access services Assist with referrals, authorizations, ID card requests, grievances, appeals and coverage decisions Document member inquiries, complaints and resolutions Identify and route utilization management and coverage determination requests Coordinate with internal departments to resolve member concerns Follow CMS requirements and established response timeframes Maintain member confidentiality and comply with HIPAA requirements Assist elderly members and their families with questions and concerns Requirements: Minimum of one year of healthcare industry experience Managed care or health plan experience preferred Must be fluent in English and Spanish Miami (Doral-Hialeah Gardens), FL 2564 3625 Northwest 82nd Avenue Suite 314 Doral, FL 33166 Express Employment Professionals Defunct