*Job Title: *Member
ervices Representative
*Targe
Compensat
- Range
- $20.00-$28.00/ho
- depending on th
- evel of relev
- qualifications
nd exp
Us:*
Astiva Heal
ange, CA is a premier he
- hcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we
rioritize a
- ssibility, affordability, and quality
all aspects of our servi
s. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
*SUMMARY:* The Member Service Specialist is responsible for answering telephonic inquiries from current and potential members and providers regarding Medicare Advantage benefits, eligibility, enrollment, claims, referral, prior authorizations, appeals & grievances and other related concerns. Our Member Service Specialists ensure customer satisfaction by providing excellent customer service, displaying a desire to help and maintaining a professional demeanor. Member Service Specialists will be expected to maintain quality and performance standards.
*ESSENTIAL DUTIES AND RESPONSIBILITIES *include the following:
• Handle inbound and outbound phone calls, emails and other necessary communications with members and providers
• Clearly identify and act on customer needs to achieve satisfaction.
• Clearly explain all details of the Medicare Advantage Plan including procedures, protocols, benefits, and any other necessary information to the member or provider during inbound and outbound calls.
• Fully understand all aspects of Medicare Advantage including but not limited to benefits, prior authorization, referrals, claims, enrollment, eligibility, appeals & grievances, providers networks and pharmacy services.
• Provide accurate and complete information using the tools provided
• Keep detailed written records of each telephone encounter during the call
• Adhere to all call center metrics as set forth by CMS regulation and call center leadership.
• Attempt to resolve the member’s issue completely during the first phone call.
• Go above and beyond to provide exceptional customer service.
*EDUCATION and/or EXPERIENCE:*
• 2+ years customer service experience
• Minimum 1+ years’ experience with Medicare Advantage
• Health Plan experience.
• Excellent verbal and written communication skills including active listening and probing techniques.
• Ability to multi-tasks, time manage and prioritize.
• Ability to document information while on the phone with the member.
• Ability to build rapport with members
• Fluent in Spanish, Korean, or Cantonese/Mandarin (verbal and written)
*BENEFITS:*
• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off
Job Type: Full-time
Pay: $20.00 - $28.00 per hour
Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Paid time off
* Vision insurance
Shift:
* 8 hour shift
Weekly day range:
* Monday to Friday
Application Question(s):
* This position is based in the Orange, CA offices, with no option for remote/hybrid work schedules. Are you looking and willing to commute into the office?
Experience:
* Medicare Advantage: 1 year (Preferred)
Work Location: In person