Senior Member Service Representative (Hybrid)
Village Center for Care, Inc., New York, NY, United States
Senior Member Service Representative
VillageCareMAX
112 Charles Street, New York, NY 10014
Under the direct supervision of the Supervisor of Member Services, the Senior Member Services Representative is responsible for handling all calls that come through our call center. They will handle more complex inquiries and grievances to serve as an escalation channel to the Member Service Representative. Responsible for assisting members in accessing services, solving problems and communicating with other members of the Interdisciplinary Care Team.
Key Responsibilities
Handles incoming telephone calls and answers questions for members and providers; assists members in accessing necessary covered and non‑covered services in conjunction with plan of care
Handle and provide analytical research and resolution to escalation calls
Conducts post‑enrollment orientation activities, including orientation of members, members' families or representatives
Explains the plan's rules for obtaining services and assists members in making appointments with their primary care physician and other health care providers
Responds to member questions and grievances; and advises members of the prerogative to complain to Department of Health or State designated entity at any time
Clarifies information in the member handbook or VillageCareMAX website for members
Advises members of the plan's grievance and appeals system, the services authorization process and the member's right to a fair hearing and/or external review; logs member and provider grievances; resolves same‑day grievances where possible
Facilitates communications between members, subcontractors, providers and Care Managers
Conducts medication reminder phone calls under the direction of the Interdisciplinary Care Team
Assists member in selection of participating providers
Assists the Interdisciplinary Care Team in performing non‑clinical assessments
Data enters authorizations under the direction of the Interdisciplinary Care Team
Education Associate degree is required; bachelor's degree is preferred.
Experience Minimum of 3 years' job related experience in health care. Experience with Managed Long Term Care and Medicare Dual Special Needs programs preferred. Demonstrated experience with PC's and related software including Windows and Microsoft Office Suite. Bilingual – Spanish is required.
Benefits
PTO package
10 Paid Holidays
Personal and Sick time
Medical/Dental/Vision
HRA/FSA
Education Reimbursement
Retirement Savings 403(b)
Life & Disability
Commuter Benefits
Paid Family Leave
Additional Employee Discounts
VillageCare is an Equal Opportunity Employer.
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VillageCareMAX
112 Charles Street, New York, NY 10014
Under the direct supervision of the Supervisor of Member Services, the Senior Member Services Representative is responsible for handling all calls that come through our call center. They will handle more complex inquiries and grievances to serve as an escalation channel to the Member Service Representative. Responsible for assisting members in accessing services, solving problems and communicating with other members of the Interdisciplinary Care Team.
Key Responsibilities
Handles incoming telephone calls and answers questions for members and providers; assists members in accessing necessary covered and non‑covered services in conjunction with plan of care
Handle and provide analytical research and resolution to escalation calls
Conducts post‑enrollment orientation activities, including orientation of members, members' families or representatives
Explains the plan's rules for obtaining services and assists members in making appointments with their primary care physician and other health care providers
Responds to member questions and grievances; and advises members of the prerogative to complain to Department of Health or State designated entity at any time
Clarifies information in the member handbook or VillageCareMAX website for members
Advises members of the plan's grievance and appeals system, the services authorization process and the member's right to a fair hearing and/or external review; logs member and provider grievances; resolves same‑day grievances where possible
Facilitates communications between members, subcontractors, providers and Care Managers
Conducts medication reminder phone calls under the direction of the Interdisciplinary Care Team
Assists member in selection of participating providers
Assists the Interdisciplinary Care Team in performing non‑clinical assessments
Data enters authorizations under the direction of the Interdisciplinary Care Team
Education Associate degree is required; bachelor's degree is preferred.
Experience Minimum of 3 years' job related experience in health care. Experience with Managed Long Term Care and Medicare Dual Special Needs programs preferred. Demonstrated experience with PC's and related software including Windows and Microsoft Office Suite. Bilingual – Spanish is required.
Benefits
PTO package
10 Paid Holidays
Personal and Sick time
Medical/Dental/Vision
HRA/FSA
Education Reimbursement
Retirement Savings 403(b)
Life & Disability
Commuter Benefits
Paid Family Leave
Additional Employee Discounts
VillageCare is an Equal Opportunity Employer.
#J-18808-Ljbffr