Member Services Representative - Bilingual

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit http://www.amidacareny.orgfor more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Senior Director of Provider Relations. This position will be a member of the senior management team. Compensation will be commensurate with experience.

Position Summary:

The Bilingual Member Services Representative position supports the Member Services Departments goal and mission to deliver the highest level of customer service and support for members and providers in a call center setting. The Member Services Representative is responsible to answer and resolve high volume of Spanish/English member and provider inquires, concerning benefits, services, and claims. This role is also responsible for completing outbound campaigns for member outreach, education, onboarding of members and quality initiative projects.

Responsibilities:

• Answer members and providers' inquiries concerning plan benefits, claims and complaints.
• Escalate complex and urgent member care needs to the appropriate Management or departments.
• Transfer members to Amida Care's Partners for Services provided on behalf of Amida Care.
• Navigate different systems and databases to resolve members' issues or concerns.
• Document all conversations/touchpoints in the Amida Care system (Salesforce).
• Meet Quality Assurance requirements and other call center key performance metrics.
• Collect and document prospective members information the Amida Care system (Salesforce).
• Conduct outbound calls for projects and member outreach follow-ups.
• Confirm and update member contact information and demographic, such as address, phone numbers & Primary Care Provider etc.
• Promote and educate members on plan benefits, services, programs, alerts, and reminders.
• Conduct New Member Orientation as assigned.
• Utilize translation line as needed to communicate with members.
• Attend events as needed: Town Hall Meetings, Live Your Life (LYL) Events, NML (New Member Luncheon).
• Provide feedback to management teams on any trending member inquiries and/ or activities for process improvement.
• Perform other duties as assigned.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

EDUCATION REQUIRED

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

EXPERIENCES AND/OR SKILLS REQUIRED

• Strong verbal and written communication skills in English and Spanish.
• Minimum one (1) years' experience in Customer Service.
• Must be able to maintain strict confidentiality of sensitive member's information (HIPAA)
• Proficiency in Microsoft Office (Word, Excel).
• Ability to sit for an extended period.
• Ability to manage multiple tasks and work consistently in a fast-paced environment.
• Understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts in accordance with the organization's vision, mission, and values.