Member Experience Representative (bilingual Spanish)

About the Role

Verda Health Plan of Texas is seeking a Member Experience Representative – Bilingual (Spanish) to join our growing team. This role is a contact center position supporting senior citizens who use Verda for Medicare Advantage healthcare insurance coverage. You will interact with members, physicians/providers, insurance brokers, and caregivers, providing excellent customer service and positively impacting our senior members.

Responsibilities

• Provide excellent customer service by addressing member inquiries, questions, and concerns regarding enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
• Educate members, family, providers, and caregivers about plan benefits and options in person, via email, or telephonically.
• Follow up with members to clarify issues, determine causes, identify solutions, and explain resolutions.
• Escalate member issues to management or other departments as required.
• Meet departmental standards for quality, productivity, schedule adherence, and attendance.
• Respond to member, internal staff, and provider inquiries via phone, omnichannel interactions, and in-person discussions.
• Take ownership of issues, focusing on providing solutions and options for members.
• Increase member satisfaction by resolving issues, complaints, and questions efficiently and accurately.
• Participate in member calling projects to support membership retention and other goals.
• Follow policies, procedures, and job aids to maintain efficient and compliant operations.
• Document interactions in applicable systems and forms, adhering to departmental standards.
• Collaborate with other departments as needed.
• Achieve individual performance goals related to call quality, attendance, schedule adherence, and call center objectives.

Requirements

• High School diploma or equivalent required.
• Bilingual and fluent in English and Spanish.
• 1-2 years of call center or related customer service experience.
• 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans.
• Experience in healthcare, insurance, or pharmacy industry is highly desirable.
• Ability to maintain a calm demeanor in charged situations.
• Data entry and general computer skills.
• Effective communication (oral and written) skills.
• Professional and pleasant telephone manner.
• Ability to handle large call volumes while providing excellent customer service.

Qualifications

• Integrity and trustworthiness.
• Customer focus.
• Functional/technical skills.
• Critical/analytical thinking.

Benefits

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental insurance
• Vision insurance
• Life insurance

Schedule

Full-time onsite (100% in-office)

Hours of operation: 9am – 6pm, Monday to Friday (weekends as needed)

Occasional travel may be required for meetings and training sessions.

Physical Demands

• Regularly sit/walk at a workstation in an office or cubicle setting.
• Occasionally lift and/or move up to 25-50 pounds.

Job Type: Full-time

Ability to commute/relocate reliably is required.