HYBRID Member Service Representative (Bilingual Mandarin)

Job Title: Hybrid Member Service Representative (Bilingual Mandarin Required)

Job Type: Full-Time
Schedule: Hybrid
Location: New York, NY

Position Overview:
We are seeking a compassionate, detail-oriented, and customer-focused Member Service Representative who is fluent in both English and Mandarin to support members and providers in navigating healthcare services and benefits. This role plays a key part in ensuring members receive exceptional service, understand their healthcare coverage, and have access to the resources they need to maintain their health and well-being.

The ideal candidate will have strong communication skills, healthcare customer service experience, and the ability to work collaboratively with interdisciplinary care teams, providers, and families.

Key Responsibilities:

• Handle incoming telephone calls and respond to questions from members and providers regarding covered and non-covered services in conjunction with the member's plan of care
• Conduct post-enrollment orientation for members, families, and authorized representatives
• Explain plan rules and procedures for obtaining services and assist members with scheduling appointments with primary care physicians and specialists
• Respond to member questions, concerns, and grievances while educating members on their rights, including their ability to file complaints with the Department of Health or designated state entities
• Clarify information outlined in the member handbook and website resources
• Educate members on the grievance and appeals process, service authorization procedures, fair hearing rights, and external review options
• Log and track member and provider grievances; resolve same-day grievances whenever possible
• Facilitate communication between members, providers, subcontractors, and Care Managers
• Conduct medication reminder phone calls under the direction of the Interdisciplinary Care Team
• Assist members in selecting participating healthcare providers
• Support the Interdisciplinary Care Team with non-clinical assessments
• Enter service authorizations under the direction of the care team
• Communicate effectively with members who have special needs using interpretation services, TTY/Telebraille, large print, Braille, adaptive talking devices, and other accessibility tools
• Assist members with Medicaid benefit renewals
• Participate in special projects and departmental initiatives as needed

Qualifications:

• Must be Bilingual in Mandarin and English (spoken and written)
• High school diploma required; Associate's or Bachelor's degree preferred
• Previous customer service experience in healthcare, managed care, insurance, or member services strongly preferred
• Knowledge of Medicaid, Medicare, or Managed Long-Term Care (MLTC) preferred
• Strong problem-solving, communication, and conflict resolution skills
• Excellent organizational skills and attention to detail
• Ability to handle sensitive and confidential information professionally
• Proficiency in Microsoft Office and data entry systems
• Ability to work independently and collaboratively in a hybrid environment

Preferred Skills:

• Experience working with diverse and underserved populations
• Familiarity with grievance and appeals processes
• Understanding of care coordination and member advocacy
• Strong empathy and commitment to delivering high-quality member support

We are looking for someone who is passionate about helping others and committed to improving the member experience through excellent service and support.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.