Bilingual Member Services Rep III – Medicare Helpdesk

Leon Health Plan; Florida; Vor Ort; USD 22.000 - 33.000; Vollzeit

Zusammenfassung

LEON Health, Inc. is seeking a Member Services Representative in Florida. The role focuses on connecting with prospective and current members, listening to questions, and delivering clear, concise solutions aiming for first-call resolution.

The candidate will handle high-volume calls, research benefits and claims, and coordinate with internal teams to resolve inquiries. Bilingual English/Spanish fluency is required.

Qualifikationen

• Understanding CMS regulatory requirements and standard operating procedures.
• Minimum of 1 year of experience in a call center within insurance managed care, preferably Medicare HMO.
• Bilingual fluency in English and Spanish.

Aufgaben

• Handle a high volume of complex calls and may process correspondence.
• Research accounts, claim history or benefits to identify issues and resolutions; guide callers to the correct department.
• Identify complaints, requests for coverage determinations or appeals, and potential fraud to escalate appropriately.
• Contribute to meeting CMS call center metrics and goals.
• Follow up with callers to provide resolutions as needed.
• Document call reasons and dispositions clearly in the call center system.
• Coordinate with different company functions to ensure timely handling of customer requests.

Kenntnisse

CMS regulations knowledge

Call center experience

Bilingual English/Spanish

Ausbildung

High School Diploma or equivalent

Jobbeschreibung

LEON Health, Inc. is seeking a Member Services Representative in Florida. The role focuses on connecting with prospective and current members, listening to questions, and delivering clear, concise solutions aiming for first-call resolution.

The candidate will handle high-volume calls, research benefits and claims, and coordinate with internal teams to resolve inquiries. Bilingual English/Spanish fluency is required.