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Now viewing: Member Services Rep. I - Bilingual - Spanish{170301}
AS
A-Line Staffing
Member Services Rep. I - Bilingual - Spanish{170301}
Job Description
Member Services Representative I- Bilingual The Member Services Representative I serves as the primary point of contact for health plan members, providers, and community partners by delivering exceptional customer service and resolving a wide range of inquiries. This role handles a high volume of inbound and outbound calls, emails, chats, and written correspondence while ensuring timely, accurate, and compassionate support. Key Responsibilities Respond to member and provider inquiries regarding benefits, eligibility, claims, authorizations, pharmacy, and health plan services. Handle high-volume phone calls, emails, chats, and written correspondence while meeting service level expectations. Research and resolve member issues, escalating complex concerns when appropriate. Accurately document all interactions in the Customer Relationship Management (CRM) system. Educate members on health plan benefits, available resources, and self-service tools. Coordinate with internal departments including Claims, Enrollment, Pharmacy, Authorizations, Case Management, and Grievance & Appeals to resolve member concerns. Assist members with appointment scheduling, benefit coordination, and navigating healthcare resources. De-escalate challenging situations while providing professional and compassionate service. Meet departmental performance goals related to quality, productivity, compliance, member satisfaction, attendance, and first-call resolution. Maintain confidentiality and comply with all regulatory and organizational policies. Qualifications High school diploma or GED required; Bachelor's degree preferred. Minimum 1-2 years of customer service or call center experience; managed care or healthcare experience preferred. Experience in health insurance, managed care, hospital, or healthcare settings preferred. Bilingual (Spanish, Cantonese, Mandarin, Vietnamese, Tagalog, Arabic, or Farsi) may be required for designated positions. Strong communication, problem-solving, multitasking, and conflict resolution skills. Proficiency with CRM systems, Microsoft Office, and data entry. Ability to work in a fast-paced, metrics-driven environment while delivering exceptional customer service. Medical terminology knowledge is a plus. Tdavis@alinestaffing.com 469-342-1411