Member Services Representative

Located in Doral, FL

Salary: 20.00

Bilingual Healthcare Customer Service Representative

We are seeking a bilingual Customer Service Representative to assist health plan members with questions regarding benefits, eligibility, coverage decisions, grievances, appeals, referrals and authorizations.

Responsibilities:

• Respond to member inquiries by phone, in writing and in person
• Explain plan benefits, eligibility, coverage and how to access services
• Assist with referrals, authorizations, ID card requests, grievances, appeals and coverage decisions
• Document member inquiries, complaints and resolutions
• Identify and route utilization management and coverage determination requests
• Coordinate with internal departments to resolve member concerns
• Follow CMS requirements and established response timeframes
• Maintain member confidentiality and comply with HIPAA requirements
• Assist elderly members and their families with questions and concerns

Requirements:

• Minimum of one year of healthcare industry experience
• Managed care or health plan experience preferred
• Must be fluent in English and Spanish

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