Member Services Specialist (Bilingual - Spanish)

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

Description

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. 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.

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off
• Free catered lunches

Requirements

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 (verbal and written)