Member Services Representative Lead
Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued.
Position is fully onsite Monday-Friday. Location: 9250 NW 36th St, Miami, FL 33178. Bilingual in English and Spanish is required.
About the Role
We're on the lookout for a passionate and dedicated individual who is ready to contribute to our mission of providing essential benefits and services that promote the health and well-being of our members. As a Lead Member Services Representative, you will support our company’s customer service activities by directing and overseeing team members, resolving customer questions or complaints, and developing programs and procedures to enhance productivity and performance.
Responsibilities
- Trains new employees in the company's customer service policies, procedures, and best practices.
- Organizes and oversees the schedules and work of assigned staff.
- Conducts performance evaluations that are timely and constructive.
- Handles discipline and termination of employees with manager as needed and in accordance with company policy.
- Monitors or reviews calls or other correspondence between representatives and customers.
- Ensures that representatives are informed about changes to company products and services.
- Collects data and prepares reports on customer complaints and inquiries.
- Prepares monthly reports summarizing the assigned customer service team’s performance.
- Identifies opportunities to update or improve customer service procedures and makes recommendations to the Director of Customer Service or other appropriate staff.
- Assists callers on inquiries regarding coverage decisions, grievances, appeals, benefit interpretation, eligibility verification, medical group/PCP, explanation of how the plan works and how to utilize services, assists with information regarding referrals or authorizations, member complaints, identification card requests.
- Responsible for maintaining customer service levels (abandonment rate, speed of answer and service level) within established parameters.
- Knowledge of plans benefit, CMS and Plans policies and procedures.
- Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
- Ensures compliance with all HIPAA, OSHA, and other federal, state and local regulations.
- Participates in meetings, trainings, and in-service education, as required.
- Interacts with other departments about member issues or concerns.
Requirements
- Bachelor’s degree preferred.
- At least three years of customer service experience required.
- Previous experience in a supervisory role preferred.
Performance Measurements
- 3-5 Monthly evaluations.
- Compliance with Department Call Metrics/Company Regulations.
- Attendance/Punctuality.
- Safety and Security.
- Quality of work.
Benefits
- Full benefits package offered on the first of the month following date of hire including: Medical, Dental, Vision.
- 401K plan with a 100% company match.
Why Join Us
Join Solis Health Plans as a Lead Member Services Representative and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. Our company has doubled in size and experienced exponential growth in membership from 2,000 members to over 7,000 members in the last year. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans.