Virginia Premier Health Plan, Inc.

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Bilingual Member Operations Representative I

Bilingual Member Operations Representative I

Job Locations 
US-VA-Chesapeake
Job ID 
2017-4133

Job Description

Overview

The Member Operations Representative I (MOR I) is responsible for informing and educating Virginia Premier Health Plan Inc. (VPHP) members on how to properly use the medical services available to them. The MOR I will handle and document all member inquiries, schedule transportation requests, verify eligibility and make necessary referrals for an appropriate resolution. The MOR I will also be responsible for data entry to enter enrollment, referral and insurance information for VPHP membership population.

Member Operations

 

As a managed care organization, the areas within Member Services play a major role for our members. Our ability to enroll and then welcome our members, secure their information, answer questions, assign primary care Physician’s and provide transportation to and from appointments is critical to the health and lives of our members.

 

Responsibilities

  •  Take calls routed through hunt groups to ensure that established monthly call standards are met.
  • Serve as a liaison between members and VPHP or Virginia Coordinated Care (VCC), ensuring that all inquiries are addressed in a timely and thorough manner and/or are forwarded to the appropriate person/department for follow-up.
  • Document all calls from Members/Providers in Pivotal
  • Provide optimal quality customer service to all callers at all times.
  • Maintain production standards as set by the department.
  • Maintain average quality score of 90%.
  • Educate VPHP and VCC Plan members on how to properly use the medical services available to them.
  • Inform potential enrollees of plan benefits and general information.
  • Verify members’ eligibility status upon request.
  • Schedule Regular, Cyclical and Multiple transportation trips for members.
  • Print and/or mail ID cards for new or existing members.
  • Report all suspected cases of member fraud and abuse to appropriate department.
  • Mail Enrollment packets upon request. 
  • Perform Primary Care Physician (PCP) changes for VPHP and VCC members.
  • Document Third Party Liability (TPL) information.
  • Perform other duties as assigned.

 

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • High school diploma or equivalent.  

SPECIAL KNOWLEDGE/SKILLS

  • Excellent customer service and telephone etiquette skills.
  • Ability to operate a PC with a Microsoft Windows operating system.
  • Strong typing/data entry skills and basic PC workstation skills.
  • Ability to communicate effectively with a diverse population.
  • Proven track record working in a professional environment, with knowledge of office protocols, machines and equipment.
  •  Excellent verbal and written communications skills required in English and Spanish

WORK BACKGROUND/EXPERIENCE

  • Minimum one (1) year customer service experience in a sales, medical, insurance or call center environment.

 

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

 

About Us

 

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

Our mission is to inspire healthy living within the communities we serve!

 

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