Customer Support/Service, Medicaid, Medicare, Call Centers, Call Volume, Customer Relations, English Language, Health Plan, Healthcare, Healthcare Providers, Multilingual, Spanish Language,
- Bilingual English/Spanish Required.
- High School Diploma or GED.
- Minimum 1 year of call center or customer service experience.
- Medicaid and/or managed care experience required.
- Knowledge of healthcare benefits, eligibility, and medical terminology.
- Experience with call center metrics (AHT, QA, FCR, Adherence).
- Strong communication, problem-solving, and computer skills.
- Typing speed of 35+ WPM.
- Handle inbound calls from Medicaid members and providers.
- Explain benefits, eligibility, coverage, claims, referrals, and authorizations.
- Research and resolve member/provider issues and concerns.
- Assist members through complaint and appeal processes.
- Document interactions accurately in system platforms.
- Maintain HIPAA compliance and protect member information.
- Provide excellent customer service while managing high call volumes.
Member Services Representative (Medicaid Hotline) – Bilingual English/Spanish Required
We are seeking a customer-focused Member Services Representative to support Medicaid members and healthcare providers in a high-volume call center environment. This role serves as the first point of contact for inquiries related to eligibility, benefits, claims, referrals, authorizations, and other health plan services.
Schedule: Monday–Friday, 8-hour shift between 7:00 AM and 6:00 PM.