Medicare Member Advocate – Bilingual | First-Call Resolution

LEON Health, Inc.; Florida; On-site; USD 32,000 - 48,000; Full time

Job summary

LEON Health, Inc. is seeking a Member Services Representative to connect with prospective and current members, listen to questions, and provide clear, concise solutions focused on first-call resolution. You will handle high-volume calls and research accounts to resolve inquiries with CMS compliance and a patient, bilingual approach.

The role emphasizes documenting interactions, coordinating with multiple teams, and ensuring timely service to members in English and Spanish.

Qualifications

• Knowledge of CMS regulatory requirements and standard operating procedures.
• High School Diploma or equivalent required.
• Minimum one year of call center experience in insurance managed care (Medicare preferred).
• Bilingual English/Spanish fluency.

Responsibilities

• Handles a high volume of complex calls and may process correspondence.
• Researches accounts, claim history, or benefits to identify issues and resolution steps.
• Identifies complaints, coverage determinations or appeals for routing to the correct department.
• Strives for first-contact resolution and meets call center metrics.
• Follows up with callers to provide responses or resolution steps.
• Documents call reasons and dispositions in the call center system.
• Coordinates with various functions to address customer requests in a timely manner.

Skills

CMS regulatory requirements knowledge

Bilingual English/Spanish

Education

High School Diploma or equivalent

Job description

LEON Health, Inc. is seeking a Member Services Representative to connect with prospective and current members, listen to questions, and provide clear, concise solutions focused on first-call resolution. You will handle high-volume calls and research accounts to resolve inquiries with CMS compliance and a patient, bilingual approach.

The role emphasizes documenting interactions, coordinating with multiple teams, and ensuring timely service to members in English and Spanish.