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Bilingual Member Services Representative

Cazador Consulting Group, INC. Bakersfield, CA

  • Expired: 13 days ago. Applications are no longer accepted.
Job Description

Our company is in the Health care industry and is looking for the perfect candidate that wants to grow with a team! We need a self-starter, articulate, multi-tasker that is good under pressure. Communication skills, attention to detail, problem solver


MUST HAVE CERTIFICATE FOR- Tier 1 Certified, Bilingual/Spanish (Please do not apply if you do not have)

30+ NWPM/typing

At least 2 years of customer service that includes high degree of problem-solving, telephone skills



Job Duties-

Daily and extensive contact with members and service providers to resolve complex issues, interpret policies/procedures, explain benefits, respond to requests for service, survey members, and solve problems.

Essential Functions-

** Work directly with members and service providers to identify and resolve health care service concerns.

** Acts as the member advocate promoting timely complaint and problem resolution, while representing us with every interaction.

** Responsible for timely, detailed, and accurate responses to member inquiries. Assists with the processing of complaints and grievances in accordance with the health plan’s grievance policies and procedures and regulatory agency requirements.

** Responds to time-critical questions with detailed and expeditious follow-up to promote accurate and timely processing of issues.

** Employs effective communication methods to promote positive and productive public relations with members, providers and other departments.

** Identifies, investigates, resolves, and reports member/provider issues to management.

** Promotes high standards of member satisfaction and access to medical care by documenting feedback from members. Any deviations from established standards are documented in QNXT and reported to management for evaluation.

** Prepares reports and submits results through the established administrative channels.

** Maintains an effective, efficient, and confidential filing and tracking system to facilitate easy retrieval of contact information while maintaining confidentiality in accordance with established policies and regulations.

** Documents all interactions with members and providers by appropriately coding and logging information in QNXT.

** Answers phones in a specified time frame, while maintaining a high quality of service for the members and providers.

** Responsible for Member Retention efforts which may include but are not limited to telephone surveys conducted to monitor member satisfaction.

** Assembles and provides current Plan information requested by members ensuring that the information is accurate.

** Responsible for assisting the Member Services Trainer with training new Member Services Representatives as they are hired.

** Assist members and providers with scheduling medical appointments and assisting with scheduling transportation needs for members.


Other Functions

** Assists management staff in completing member services, related special projects.

** Organizes and maintains departmental files, records, handbooks, and manuals.

** Utilizes personal computer for detailed data analysis, report generation, documentation, and project evaluation purposes.

** Adheres to all company policies and procedures relative to employment and job responsibilities.



Employment Standards



High School Diploma from an accredited school or equivalent.



Two (2) or more years of recent experience in a customer service organization or related field with a high degree of problem solving and decision making. Strong telephone and communication skills required.

Typing skills of 30+ NWPM; Required.

Knowledge of: Excellent customer service and telephone techniques and etiquette. Health Maintenance Organizations (HMO) desirable.

Ability to: Work under pressure; work independently and manage multi-task responsibilities; be willing and able to assist and educate the member; intervene effectively in a crisis situation on behalf of an upset, distraught, dissatisfied, confused or angry member; solve complex and comprehensive problems; organize and set priorities; adhere to state and federal timelines; have excellent communication skills both written and verbal and work in a rapidly evolving work environment.



Cazador Consulting Group, INC.


1234 20th street

Bakersfield, CA



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