Medicare Member Experience Specialist

Astiva Health; Orange (CA); On-site; USD 52,000 - 78,000; Full time

Benefits offered by this job

401(k)

Dental Insurance

Health Insurance

Life Insurance

Vision Insurance

Paid Time Off

Free catered lunches

Job summary

Astiva Health, Inc. in Orange, CA, is hiring a Member Service Specialist to handle Medicare Advantage inquiries from members and providers.

You will resolve benefits, eligibility, enrollment, claims, referrals, and authorizations while using tools to provide accurate information with professionalism. The role requires 2+ years in customer service, 1+ year in Medicare Advantage, health plan familiarity, and strong verbal/written communication.

Qualifications

• 2+ years of customer service experience.
• Minimum 1+ year experience with Medicare Advantage.
• Health Plan experience.
• Excellent verbal and written communication, active listening.
• Ability to multi-task, manage time, and prioritize.
• Ability to document information while on the phone.
• Ability to build rapport with members.
• Fluency in Spanish (verbal and written).

Responsibilities

• Handle inbound and outbound phone calls, emails and other communications with members and providers.
• Clearly identify and address customer needs to achieve satisfaction.
• Explain all Medicare Advantage details, procedures, benefits, and information to members/providers.
• Understand all aspects of Medicare Advantage including benefits, prior authorizations, referrals, claims, enrollment, eligibility, appeals, grievances, provider networks, and pharmacy services.
• Provide accurate information using the tools provided.
• Keep detailed written records of each telephone encounter.
• Adhere to call center metrics as set by CMS and leadership.
• Aim to resolve the member issue on the first call; provide exceptional service.

Skills

Customer service

Medicare Advantage

Verbal and written communication

Multi-tasking / time management

Documentation on calls

Rapport building

Spanish fluency

Job description

Astiva Health, Inc. in Orange, CA, is hiring a Member Service Specialist to handle Medicare Advantage inquiries from members and providers.

You will resolve benefits, eligibility, enrollment, claims, referrals, and authorizations while using tools to provide accurate information with professionalism. The role requires 2+ years in customer service, 1+ year in Medicare Advantage, health plan familiarity, and strong verbal/written communication.