Member Service Representative (Bilingual)

Member Services Representative (Healthcare) Position Overview The Member Services Representative serves as the primary point of contact for members and providers, delivering exceptional customer service and support. This role focuses on assisting members in navigating their healthcare benefits, accessing services, resolving concerns, and ensuring a seamless member experience. Key Responsibilities Answer incoming calls from members and providers, addressing questions related to benefits, services, and care plans Assist members in accessing covered and non-covered services, including scheduling appointments with primary care physicians and specialists Conduct post-enrollment orientations for members, families, and representatives, explaining plan benefits, policies, and procedures Educate members on how to obtain services, use their benefits, and navigate the healthcare system Respond to and document member inquiries, complaints, and grievances; resolve same-day issues when possible Inform members of their rights, including grievance and appeals processes, fair hearings, and external review options Clarify information from member materials, including handbooks and online resources Facilitate communication between members, providers, subcontractors, and the Interdisciplinary Care Team Provide medication reminder calls as directed by the care team Assist with non-clinical assessments and data entry of service authorizations Support members with Medicaid renewal and eligibility-related processes Communicate effectively with individuals with diverse needs using interpretation services and adaptive communication tools (e.g., TTY, large print, braille) Participate in special projects and support departmental initiatives as needed Qualifications Education: High School Diploma or equivalent required Experience: Minimum of 3 years of experience in a healthcare or call center environment Experience supporting Medicaid and/or Medicare populations preferred Strong computer skills, including Microsoft Office Suite Bilingual (preferred but not required) Core Competencies Customer Service Excellence:

Strong ability to provide empathetic, member-focused support Healthcare Knowledge:

Understanding of healthcare services, insurance, and managed care Communication Skills:

Clear, professional verbal and written communication abilities Problem Solving:

Ability to assess issues, identify solutions, and resolve concerns efficiently Organization & Multitasking:

Capable of managing multiple priorities in a fast-paced environment Cultural Competency:

Ability to work effectively with diverse populations and sensitive situations Team Collaboration:

Works effectively with interdisciplinary teams and external partners Integrity & Accountability:

Maintains confidentiality and adheres to compliance standards