Member Services Advocate-Bilingual Required

Full-Time

Remote in CA, NV, AZ, TX

About SCAN

SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada.

SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.

SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere.

Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities.

SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit , , or follow us on LinkedIn, Facebook, and Twitter.

The job

Serves members by being an advocate and point of contact for member questions and concerns regarding benefits, eligibility, referrals, claims and any other aspects of plan benefits and services.

Ensures member satisfaction by providing superior customer service and willingness to help at all time while maintaining a professional demeanor.

You will

• Provides quality customer service by apply SCAN Five Service Principles. Educates members, family, providers and caregivers regarding benefits and plan options.
• Accurately explains benefits and plan options in person, via email or telephonically.
• Provides follow-up with members by clarifying the customer’s issue, determining the cause, and identifying and explaining the solution.

Escalates appropriate member issues to management or other departments as required.

• Consistently meets and / or exceeds the departmental standards, including, but not limited to : quality, productivity, and adherence to schedule and attendance.
• Responds appropriately and in a timely fashion to member / internal staff / providers by answering telephonic and written inquiries concerning benefits, eligibility, referrals, claims and all other issues following departmental policies and procedures and job aids.

Takes ownership of the issue, focusing on providing solutions and options for member, as necessary through resolution of member issue.

Increases member satisfaction by following up and resolving member issues, complaints, and questions in an efficient, timely and accurate fashion;

coordinates resolution with providers and other departments as needed.

• Participates in member calling projects as assigned by management to support the overall SCAN goal of membership retention.
• Follows policies and procedures and job aids in order to maintain efficient and complaint operations; communicates suggestions for improvement and efficiencies to management;

identifies and reports problems with workflows following proper departmental procedures; actively participates in departmental staff meetings and training sessions.

Follows all appropriate Federal and State regulatory requirements and guidelines applicable to Scan Health Plan operations, as documented I company policies and procedures.

Follows all HIPAA requirements.

• Documents transactions by completing applicable member forms and summarizing actions taken in appropriate computer system and following standards set by the department or by other authorized individuals.
• Temporarily responds to routine member questions and concerns on specific medical group call queues as part of skill development.
• Contributes to team effort by accomplishing related results as needed.

Your qualifications

• Required : High School diploma or equivalent required.
• 1-2 years call center or related customer service experience, required.
• 1-2 years of prior experience with Medicare benefits, including Medicare Advantage Plans preferred.
• Experience in the healthcare, insurance or pharmacy industry high desirable.
• Ability to maintain calm demeanor at all times, including during highly charged situations.
• Data entry and general computer skills (word processing, e-mail) required.
• Effective communication (oral and written) skills. Professional / pleasant telephone manner required.
• Ability to handle large call volume, while providing excellent customer service at all times required.
• Demonstrated efficiency / effectiveness in an environment with a high call volume.

What’s in it for you?

• Base salary range : $ to $ per hour
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Holiday pay plus 1 floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• A work-life balance
• An opportunity to become part of a team that makes a difference to our members and our community every day!

Last updated : 2024-05-30