What are the responsibilities and job description for the Member Services Representative- English /Spanish/Vietnames Bilingual position at Medcare Partners Health Plan of Texas?
Job Summary
MedCare Partners Health Plan of Texas is seeking a friendly, dependable, and compassionate Member Services Representative to assist Medicare Advantage members with questions regarding their health plan.
The representative will answer incoming member calls, provide accurate information, document member interactions, assist with routine member-service requests, and appropriately route or escalate issues that require assistance from other health plan departments.
Key Responsibilities
Answer incoming calls from health plan members
Provide courteous, accurate, and professional customer service.
Assist members with questions regarding:
Eligibility and enrollment
Health plan benefits and coverage
Member ID cards
Primary Care Physician (PCP) information
Provider and specialist information
Prior authorization status
Prescription drug/pharmacy questions
Transportation and supplemental benefits, when applicable
General health plan information
Document all member calls and interactions accurately in the appropriate system.
Verify member information before discussing protected information.
Protect member privacy and comply with HIPAA requirements.
Recognize complaints or potential grievances and escalate them according to health plan procedures.
Route appeals, authorization issues, pharmacy matters, claims issues, and other specialized inquiries to the appropriate department when necessary.
Follow approved Member Services scripts, policies, procedures, and training.
Never provide medical advice or information outside the representative's authorized scope.
Participate in required training and quality-monitoring activities.
Qualifications
Fluent in English– required.
Strong verbal communication skills.
High school diploma or equivalent required.
Customer service or call-center experience preferred.
Healthcare, health insurance, Medicare, Medicaid, or Medicare Advantage experience is highly preferred.
Comfortable assisting senior members by telephone.
Patient, professional, compassionate, and able to explain information clearly.
Good computer and data-entry skills.
Ability to learn health plan benefits, terminology, systems, policies, and procedures.
Ability to maintain confidentiality and appropriately handle protected health information. We are seeking a dynamic and customer-focused Member Services Representative to join our team! In this vital role, you will serve as the primary point of contact for members, providing exceptional service and support across a range of banking and financial services. Your energetic approach will help foster strong relationships, ensure smooth transaction processing, and promote our suite of banking products. If you thrive in a fast-paced environment, enjoy engaging with people, and have a passion for financial services, this is the perfect opportunity to grow your career while making a positive impact on our members’ financial well-being.
Qualifications
- Excellent communication skills with the ability to build rapport and manage relationship management effectively.
- Ability to process cash transactions accurately using 10-key typing skills while maintaining attention to detail.
- Familiarity with fraud prevention techniques, cash drawer handling, debits & credits, and cash management practices.
- Demonstrated understanding of industry knowledge of financial regulations and compliance standards necessary for secure operations.
Join us as a Member Services Representative where your enthusiasm for finance meets your dedication to delivering outstanding customer service! Bring your technical proficiency, relationship management skills, and passion for helping others to our team — together we’ll create memorable experiences that keep our members coming back!
Pay: $17.00 - $23.00 per hour
Work Location: In person
Salary : $17 - $23