·Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the member

·Effectively refers and enrolls members to appropriate internal specialists and programs, based on member’s needs and eligibility

·Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence.

·Resolve member service inquiries related to:

1.Medical benefits, eligibility and claims

2.Terminology and plan design

3.Financial spending accounts

4.Pharmacy benefits, eligibility and claims

5.Correspondence requests

·Educate members about the fundamentals of health care benefits including:

1.Managing health and well being

2.Maximizing the value of their health plan benefits

3.Choosing a quality care provider and appointment scheduling

4.Pre - authorization status

·Assist members in appointment scheduling to proactively address gaps in care

Intervene with care on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed

·Research complex issues across multiple databases and work with support resources to resolve customer issues and / or partner with others to resolve escalated issues.

·Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance

·Maximizes use of community services, support programs, and resources available to member

·High School diploma / GED or higher OR 10+ years of equivalent working experience

·2+ years in a Customer Service environment or equivalent customer service skills and experience.

·Bilingual fluency in Chinese (Cantonese and Mandarin) and English

·All new hires will be required to successfully complete the Customer Service training classes and demonstrate proficiency of the material

·Proficient in translating healthcare - related jargon and complex processes into simple, step - by - step instructions customers can understand and act upon

·Work 40 hours per week. Shift 9:00 am - 5:30 pm EST Monday – Friday, may change different shifts as business needs in future; Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust work schedule and work over-time as needed

·Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner, consistently meeting commitments)

·Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member

·Proficient problem solving approach to quickly assess current state and formulate recommendations

·Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrating personal resilience

·Flexibility to customize approach to meet all types of member communication styles and personalities