Member Services Representative II

Skills

• Spanish language fluency
• Customer service skills
• Healthcare knowledge
• Enrollment and claims processing
• Problem-solving and issue resolution

About the role

The Spanish Bi-lingual Member Services Representative II plays a crucial role in engaging and educating members of the hospitality and gaming industry. They serve as the primary point of contact for inquiries regarding benefits, claims, and eligibility, and are responsible for encouraging members to participate in health improvement programs.

Responsibilities

• Serve as the main point of contact for the Fund’s members, unions, employers, providers, and vendors on benefit, claims, and eligibility issues
• Record and record telephone inquiries regarding plan benefits, claims, and eligibility
• Back up Member Services I and Reception positions for walk-in inquiries
• Perform telephonic enrollment functions and in-person outreach as needed
• Encourage members to take steps to improve their health
• Recognize and communicate issues to management including trends and anomalies
• Research benefit, eligibility, and claim issues and initiate corrective action with relevant departments
• Maintain up-to-date knowledge of all systems and sources relating to plan benefits, processes, policies, etc.
• Seek management assistance on issues unable to resolve in a timely manner
• Monitor work volumes and service levels

Requirements

• Spanish bi-lingual skill
• Minimum 1-2 years of direct experience in a healthcare, insurance, union, or community engagement environment
• Working knowledge and experience in enrollment requirements and processes
• Experience in customer service duties in person and/or over the phone
• Experience in a call center
• Working knowledge in complex claims processes, complex self-pay processes including payment, vacation hours, and leave of absence application
• Associate’s degree in healthcare or related field or equivalent work experience required

Pay

$20.36 - $24.97 per hour. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Schedule

Monday ~ Friday, 7.5 hours per day (37.5 hours per week) with potential for hybrid work-from-home arrangement.

Benefits

• Medical
• Dental
• Vision
• Paid Time-Off (PTO)
• Paid Holidays
• 401(k)
• Pension
• Short- & Long-term Disability
• Life
• AD&D
• Flexible Spending Accounts (healthcare & dependent care)
• Commuter Transit
• Tuition Assistance
• Employee Assistance Program (EAP)