HYBRID Member Service Rep Bilingual Mandarin Cantonese
2 days ago
New York
Job Description Member Services Representative (Bilingial Mandarin/ Cantonese) Schedule: Monday-Friday, 9:00 AM - 5:00 PM (must be flexible for occasional weekend coverage) Position Summary We are seeking a dedicated Member Services Representative to support members and providers by ensuring access to necessary healthcare services and resources. This role serves as a key point of contact for members, assisting with questions, service coordination, grievance resolution, and education on plan benefits. The ideal candidate has a healthcare background, strong communication skills, and the ability to work collaboratively with care teams and providers. Key Responsibilities * Handle incoming telephone calls from members and providers; answer questions and assist members in accessing covered and non-covered services in coordination with the plan of care. * Conduct post-enrollment orientation for members, families, or representatives. * Explain plan rules for obtaining services and assist members with scheduling appointments with primary care physicians and other healthcare providers. * Respond to member inquiries and grievances; inform members of their right to contact the Department of Health or other designated entities at any time. * Clarify information contained in the member handbook and website resources. * Educate members on the grievance and appeals process, service authorization procedures, and members' rights to fair hearings and external reviews. * Log member and provider grievances and resolve same-day grievances when possible. * Facilitate communication between members, providers, subcontractors, and Care Managers. * Conduct medication reminder calls under the direction of the Interdisciplinary Care Team. * Assist members with selecting participating providers. * Support the Interdisciplinary Care Team with non-clinical assessments and administrative tasks. * Enter authorizations under the direction of the Interdisciplinary Care Team. * Communicate effectively with members who have special needs using tools such as interpretation services, TTY/Telebraille, large print/Braille, or adaptive communication equipment. * Assist members with Medicaid renewal processes. * Participate in special projects and initiatives as needed. General Competencies * Industry Knowledge: Understanding of healthcare systems, including provider services and payment structures such as Medicaid and Medicare. * Planning & Organization: Ability to prioritize tasks, manage resources, and meet deadlines. * Problem Analysis: Identify issues, evaluate relevant information, and determine effective solutions. * Professional Judgment: Handle sensitive or emotionally charged situations with diplomacy and objectivity. * Resource Coordination: Monitor and manage processes efficiently to achieve program goals. * Integrity & Accountability: Demonstrate reliability, professionalism, and adherence to organizational compliance standards. * Communication Skills: Strong verbal and written communication skills with the ability to interact with members, providers, and internal teams. * Facilitation Skills: Ability to guide discussions, resolve conflicts, and collaborate effectively with groups. Education & Experience * High School Diploma required. * Minimum 3 years of healthcare-related experience required. * Experience working in a health plan environment strongly preferred. * Proficiency with PCs and Microsoft Office Suite (Word, Excel, Outlook). * Bilingual candidates preferred. Required Skills * Healthcare background (health plan experience preferred) * Strong customer service and communication skills * Ability to manage member inquiries and service coordination 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. Company DescriptionHere at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine. Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?