HYBRID Member Service Representative (Bilingual Mandarin) - 251358

Member Services Representative (Healthcare)Position OverviewThe Member Services Representative serves as the primary point of contact for members and providers, delivering exceptional customer service and support. This role focuses on assisting members in navigating their healthcare benefits, accessing services, resolving concerns, and ensuring a seamless member experience.Key ResponsibilitiesAnswer incoming calls from members and providers, addressing questions related to benefits, services, and care plansAssist members in accessing covered and non-covered services, including scheduling appointments with primary care physicians and specialistsConduct post-enrollment orientations for members, families, and representatives, explaining plan benefits, policies, and proceduresEducate members on how to obtain services, use their benefits, and navigate the healthcare systemRespond to and document member inquiries, complaints, and grievances; resolve same-day issues when possibleInform members of their rights, including grievance and appeals processes, fair hearings, and external review optionsClarify information from member materials, including handbooks and online resourcesFacilitate communication between members, providers, subcontractors, and the Interdisciplinary Care TeamProvide medication reminder calls as directed by the care teamAssist with non-clinical assessments and data entry of service authorizationsSupport members with Medicaid renewal and eligibility-related processesCommunicate effectively with individuals with diverse needs using interpretation services and adaptive communication tools (e.g., TTY, large print, braille)Participate in special projects and support departmental initiatives as neededQualificationsEducation:High School Diploma or equivalent requiredExperience:Minimum of 3 years of experience in a healthcare or call center environmentExperience supporting Medicaid and/or Medicare populations preferredStrong computer skills, including Microsoft Office SuiteBilingual (preferred but not required)Core CompetenciesCustomer Service Excellence: Strong ability to provide empathetic, member-focused supportHealthcare Knowledge: Understanding of healthcare services, insurance, and managed careCommunication Skills: Clear, professional verbal and written communication abilitiesProblem Solving: Ability to assess issues, identify solutions, and resolve concerns efficientlyOrganization & Multitasking: Capable of managing multiple priorities in a fast-paced environmentCultural Competency: Ability to work effectively with diverse populations and sensitive situationsTeam Collaboration: Works effectively with interdisciplinary teams and external partnersIntegrity & Accountability: Maintains confidentiality and adheres to compliance standards

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