Impress employers and recruiters.
Choose from hundreds of resume examples.

Impress employers and recruiters.
Choose from hundreds of resume examples.

Target Resume Now

About the Role

This role is essential for providing customer service assistance to both English and Spanish speaking members, managing member outreach and support through an inbound/outbound call center. Responsibilities include member education, intervention, retention efforts, and handling complaints.

Responsibilities

• Receive inbound calls for HSNP lead line English and Spanish queues
• Identify and resolve member inquiries by clarifying, researching, and exploring solutions, escalating unresolved problems
• Remind members about pending Care Alerts and seasonal promotions
• Triage member concerns and request follow-ups with other departments
• Utilize translation line for non-English/Spanish speaking members
• Navigate different databases and information warehouses to resolve member issues
• Contact and warm transfer members to delegated entities for specific concerns
• Follow call scripts and guides in Spanish and English, documenting conversations in the call center database/CRM
• Meet Quality Assurance requirements and other call center key performance metrics
• Create leads and assist prospective members with Medicaid transfer
• Identify discrepancies in member eligibility and coordinate with IT for enrollment/disenrollment
• Make outbound calls for HSNP projects and conduct outreach follow-ups
• Update PCP information, perform demographic changes, and process ID card requests
• Assist in filing and resolving member complaints
• Track and conduct New Member Orientations (NMO) as assigned
• Conduct special events outreach and update RSVP lists
• Conduct Panel Transfer as assigned
• Participate in Peer Trainings
• Assist with MSA assignments as needed
• Attend events such as Town Hall Meetings, Live Your Life (LYL) Events, and New Member Luncheons
• Report enrollment issues and/or trends to Management
• Participate in quality reviews and/or reports
• Participate and conduct tests and/or analysis and provide feedback for improvement
• Perform other duties as assigned

Requirements

• Must be able to maintain strict confidentiality of sensitive member 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
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values

Skills

• Customer Service
• English and Spanish communication
• Call center operations
• Member outreach
• Member education
• Member retention
• Complaint resolution
• Microsoft Office Suite
• Adobe
• Critical thinking
• Prioritization
• Interpersonal skills
• Cultural sensitivity

Experience Level

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

Education Level

• High School Diploma or equivalent