Member Service Representative - Fort Lauderdale, FL (109799674)
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The Member Service Representative (MSR) supports the day-to-day activities of the Call Center. The MSR handles member inquiries and complaints and assists MCNA in the provision of member enrollment. The MSR assists in compliance with regulatory agencies and participates in the Quality Improvement Committee when requested.
This position is full - time (40 hours / week), Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 8:00 PM EST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 200 WEST CYPRESS CREEK ROAD, FORT LAUDERDALE, FL, 3084. This role is an onsite role and once training is completed, you will transition to work in the office in the future. Training will be conducted virtually from your home.
- Follows all relevant MS policies and procedures
- Assists in the development of MS reports and the review, and analyses of MS telephone and complaint reports and statistics to identify trends and problems which need addressing
- Works with Quality Management and other departments to assess and improve member services
- Works on a daily basis to ensure efficient management of all member complaints and inquiries
- Monitors all potential grievance cases and forwards them to Grievance / Appeals in a timely manner
- Responsible for responding to incoming calls from members, providers, clients, and internal departments regarding eligibility, plan benefits, enrollment, and general information
- Responsible for outbound calls for welcome, call backs, surveys and others as assigned
- Responsible for solving related problems in a timely fashion, meeting departmental standards for resolution within 7 calendar days, and reporting unsolved issues or problems to Management
- Maintains professionalism and cultural competence in dealing with client issues
- Maintains at a minimum satisfactory ACD statistics for performance based on departmental standards and service requirements. This includes the departmental ACD average calls / day, Average Hold Time, Availability %, and other Service Level standards
- Maintains scores of 90% or better on Service Observations and Blind calls
- Maintains up-to-date desk references, applicable policies and procedures, and other pertinent information
- Attends and meets requirements for ongoing education and departmental in-services
- Provides benefit interpretation for member questions related to member benefits
- Participates in the Dental Management Committee to notify the Quality Improvement department of any actual/potential quality of care/service problems identified when requested
- Works in collaborative fashion with the Quality Management department to ensure resolution of problem areas identified
- Ensures that department policy and procedures are adhered to meet MCNA, CMS and State Regulatory standards
- Performs other duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- High School Diploma / GED (or higher) OR equivalent years of work experience
- 2+ years of customer service experience
- Ability to work any full - time (40 hours / week) 8-hour shift between the hours of 8:00 AM - 8:00 PM EST from Monday - Friday including the flexibility to work occasional overtime holidays based on business need
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
- Experience in a call center
- Experience in Medicaid managed care
- Bilingual fluency in English and Spanish OR Trilingual fluency in English and Spanish / Creole (French) / Swahili
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military
Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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