Jobs at Amida Care (Now Hiring) — 5 open

The Bilingual Member Services Representative position is responsible and essential in providing customer service assistance to English and Spanish speaking members. This position will assist the Member Services management in the implementation, overall planning and day to day management of member outreach and support via the inbound/outbound call center in English and Spanish. These services include new member orientation and education; ongoing individual and group member education; provision of direct intervention to assist members to access services; facilitation of member retention efforts including CBO and CHOW outreach; development and provision of member materials; and a system to ensure receipt and documentation of all member complaints for follow up, investigation and resolution in English and Spanish. This position is also responsible for assisting, sharing, and reporting the Recertification /Retention process; this process includes conducting New Member Orientations (NMO) and member requests follow-up in monitoring, reviewing and assisting in any area concerning member retention, assisting with the coordination and completion of required recertification/retention outreach and inbound/outbound call center operations in English and Spanish.

ESSENTIAL FUNCTIONS

Essential functions are job duties and responsibilities that must be performed to accomplish the purpose/ goals of the job.

•    Receive inbound calls for HSNP lead line English and Spanish queues

•    Identify and resolve member’s inquiry by clarifying, researching and exploring answers and alternative solutions, and escalating unresolved problems

•    Remind members on their pending Care Alerts about getting the services like a PCP visit, STD testing, Viral Loads and Breast cancer screening, and etc.) and/or other Seasonal promotions (i.e. flu-shots)

•    Triage member’s concern and request for follow-ups with other departments of the Organization such as Pharmacy, Health Services, Care Coordination, RICU, Behavioral Health and Provider Services to  assist members with any related concerns outside Member Services’ scopes

•    Utilize translation line for non-English/Spanish speaking members

•    Navigate different database and information warehouses to resolve member’s issues or concerns (i.e. ESI, CRM, ePACES, and Care Compass)

•    Contact and warm transfer members to Amida Care’s delegated entities (Davis Vision, Healthplex, and Beacon) for questions/concerns regarding vision, dental or behavioral health issue

•    Follow call script and guides in Spanish and English and document all conversations in the call center database and/or CRM system in a comprehensible way

•    Meet Quality Assurance requirements and other call center key performance metrics

•    Create lead and assist any perspective member with Medicaid transfer

•    Identify any discrepancies on member’s eligibility (active and/or inactive membership) via ePACES and coordinate with IT if members need to be disenrolled or enrolled in the Amida Care’s main tracking system

•    Make outbound calls for HSNP projects and conduct outreach follow–ups on After-Hour’s call log

•    Update PCP information, perform demographic changes and process request of ID Cards

•    Assist in filing and resolving member complaints

•    Track and conduct New Member Orientation (NMO) as assigned

•    Conduct special events outreach and update RSVP lists for member events

OTHER RESPONSIBILITIES

Include other significant responsibilities needed to accomplish job purpose/goals that are performed on a daily or infrequent basis. 

•    Conduct Panel Transfer as assigned

•    Participate in Peer Trainings

•    Assist with MSA (Member Service Assistants) assignments as needed

•    Attend events as needed: Town Hall Meetings, Live Your Life (LYL) Events, NML (New Member Luncheon

•    Report all enrollment issues and/or trends to the Management

•    Participate in quality reviews and / or reports as requested

•    Participate and conduct test and / or analysis and provide feedback for improvement (i.e. CRM/Salesforce, Healthy Rewards Program, Pharmacy and Member Services queues, and etc.)

•    Perform other duties as assigned

MINIMUM REQUIREMENTS

•    Must be able to maintain strict confidentiality of sensitive member’s information (HIPAA)

•    High School Diploma or equivalent combination of education and relevant work experience required

•    Minimum three (3) years’ experience in Customer Service

•    Must be able to speak and read both English and Spanish fluently

•    Experience in Health Care Member Retention experience, preferred

•    Demonstrate experience with Medicaid and Medicare, preferred

•    Demonstrate proficiency in Microsoft Office (Word, Excel, Access, Outlook, PowerPoint and Publisher) and Adobe

•    Demonstrate strong verbal and written communication skills

•    Demonstrate strong critical thinking and prioritization skill

•    Demonstrate ability to meet deadlines in a fast paced environment

•    Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts

•    Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values