Member Experience Representative, Bilingual; Spanish

Workforce Opportunity Services (WOS)is a leading 501(c)(3) nonprofit dedicated to developing the skills of high-potential individuals who may not have access to career opportunities. Through strategic partnerships, WOS connects motivated talent with organizations seeking to expand their workforce with skilled professionals.

Utilizing a scientifically based model derived from research conducted at Columbia University, we recruit, educate, train, and place high-potential talent with leading organizations around the world.

• This is Member Experience Representative positions in a contact center supporting members who are senior citizens covered by Medicare Advantage plan. In some cases, the Member Experience Representative also interacts with physicians and providers, insurance brokers and members' caregivers. The work mixes phone calls, email and other written channels, and in-person conversations, so there is more variety than a typical contact center job.
  
  Member Experience Representatives balance those interactions with documenting and servicing members in the company's software systems, which takes strong multitasking.

• The Member Experience Representative provides quality customer service by addressing member inquiries, questions and concerns about enrollment, claims, benefit interpretation, and referrals and authorizations for medical care. The Member Experience Representative receives, answers and directs member calls and written questions, and educates members, family, providers and caregivers about benefits and plan options. The role also has some in-person interactions with members.

• Provide excellent customer service.
• Accurately explain benefits and plan options in person, by email or by phone, including to members, family members, providers and caregivers.
• Follow up with members by clarifying the issue, determining the cause, identifying how to resolve it and explaining the solution.
• Escalate member issues to management or other departments as required.
• Meet or exceed departmental standards for quality, productivity, and schedule and attendance adherence.
• Respond in a timely way to members, internal staff and providers through phone calls, omnichannel interactions and in-person discussions about benefits, eligibility, referrals, claims and other issues, following policies, procedures and job aids.
• Take ownership of an issue and focus on solutions and options for the member through resolution.
• Increase member satisfaction by following up on and resolving issues, complaints and questions efficiently and accurately, coordinating with providers and other departments as needed.
• Take part in member calling projects assigned by management, such as membership retention.
• Follow policies, procedures and job aids to keep operations efficient and compliant. Suggest improvements and report workflow problems through the proper channels. Take part in staff meetings and training.
• Follow all applicable federal and state regulatory requirements and all HIPAA requirements.
• Document interactions by completing member forms and summarizing actions taken in the computer system, following department standards.
• Work with other departments as needed.
• Meet attendance and schedule adherence expectations and individual performance goals such as call quality and attendance.
• Other duties as assigned.

• Bilingual:
  Fluent in English and Vietnamese.
• High school diploma or equivalent.
• 1 to 2 years of call center or related customer service experience.
• 1 to 2 years of experience with Medicare benefits, including Medicare Advantage plans.
• Experience in the healthcare, insurance or pharmacy industry is highly desirable.
• Ability to stay calm in charged situations.
• Data entry and general computer skills.
• Effective written and oral communication and a professional, pleasant telephone manner.
• Ability to handle high call volume while giving excellent customer service, with a record of efficiency in a high-volume environment.

Physical demands

• Regularly sit or walk at a workstation in an office or cubicle setting
• Occasionally lift or move 25 to 50 pounds.

• Full-Time (40 hours/Week)
  • Monday-Friday
  • 9:00AM-6:00PM

• $20.00 - 22.00/Hour (Plus Benefits)

• Carrolton,TX
  • On-Site
    - Must be able to commute reliably
  • Occasional travel for meetings and training

• 401(k)
• Paid time off
  • Vacation
  • Holiday
  • Sick Leave
• Health insurance
  • Medical
  • Dental
  • Vision
• Life…