Senior Member Service Representative (Hybrid; Bilingual - Spanish)

Job Description

Senior Member Service Representative (Hybrid; Bilingual - Spanish)

VillageCareMAX

112 Charles Street, New York, NY 10014

COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE!

Under the direct supervision of the Supervisor of Member Services, the Senior Member Services Representative is responsible for handling all calls that come through our call center. The Senior Member Services Representative will handle more complex inquiries and grievances to serve as an escalation channel to the Member Service Representative. Responsible for assisting member in accessing services, solving problems and communicating with other members of the Interdisciplinary Care Team.

Some daily responsibilities will include:

• Handles incoming telephone calls and answers questions for members and providers; assists members in accessing all necessary covered and non-covered services in conjunction with plan of care
• Handle and provide analytical research and resolution to escalation calls.
• Conducts post-enrollment orientation activities, including orientation of members, members' families or representatives
• Explains the plan's rules for obtaining services and assists members in making appointments with their primary care physician and other health care providers
• Responds to member questions and grievances; and advising members of the prerogative to complain to Department of Health or State designated entity at any time
• Clarifies information in the member handbook or VillageCareMAX website for members
• Advises members of the plan's grievance and appeals system, the services authorization process and the member's right to a fair hearing and/or external review; Log member and provider grievances; Resolves same day grievances where possible.
• Facilitates communications between members, subcontractors, providers and Care Managers
• Conducts medication reminder phone calls under the direction of the Interdisciplinary Care Team
• Assists member in selection of participating providers
• Assists the Interdisciplinary Care Team in performing non- clinical assessments
• Data enterers authorizations under the direction of the Interdisciplinary Care Team

Education: Associate degree is required; bachelor's degree is preferred.

Experience: Minimum of 3 years' job related experience in Health Care; Experience with Managed Long Term Care and Medicare Dual Special Needs programs preferred; Demonstrated experience with PC's and related software including Windows and Microsoft Office Suite; Bilingual - Spanish is required.

There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you!

• PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life & Disability, Commuter Benefits, Paid Family Leave, Additional Employee Discounts

VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.

VillageCare is an Equal Opportunity Employer.

Job Posted by ApplicantPro