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Member Service Representative

HealthCare Talent Rancho Cucamonga, CA
  • Expired: over a month ago. Applications are no longer accepted.

Our client is a large Managed Care Provider in the Inland Empire. This is an ideal position for a Member Services Rep who is looking to work for an organization that prides itself on taking care of its employees, and has an amazing culture!

Position Summary/Position

Under the direction of the Call Center Member Services Supervisor, will anticipate, document and respond to Members’ needs and represent our client in a friendly and professional manner. The MSR I will work in concert with other departmental Team Members to achieve 5 Star Service and call center goals.

Major Functions (Duties and Responsibilities)

1. Provide Member’s with health plan education in regards to and Medi-Cal benefit coverage, including understanding coordination of benefits and eligibility rules.
2. Meet the Member Services Call Center standard and policy requirements. This includes, but is not limited to the following; successful completion of Member Services Training, active participation in continuous training, use telephone system and other equipment appropriately and for professional reasons only, follow required call scripts and adhere to Attendance/Punctuality and Dress Code policy.
3.Provide superior service that delights caller in all aspects of the interaction including:
a. Strive to assist caller on the first point of contact. Demonstrate a high level of patience and respect; avoid distractions to ensure each caller is assisted promptly and appropriately; follow call handle standards and objectives.
b.Assist with Member primary care/facility assignments, selections and changes; health care options liaison; health education advisory; supply eligibility status of Members to providers
c.Member education including tagging, material request, programs, ordering ID cards and accessing services.
d.When necessary present cases to Member Services Management Team and work with other departments to resolve Member and/or Provider inquiries and/or issues. Including but not limited to transportation requests, interpreter requests, referrals questions/concerns, re-directions, Behavioral Health, and Pharmacy inquiries.
e.Document accurately while speaking with the caller. Complete Member Satisfaction Surveys and Assessments, as needed. Over 100% call documentation is required
f.Proper and timely intake of Member grievances
4.Coordinate telephonic translation of calls when Members do not speak English or Spanish.
5. Participate in Member Services Department meeting, which is held approximately twice a month on a Wednesday from 7:00 am to 8:00 am. Also, responsible for attending monthly TQM which are conducted from 7:00 am to 8:00 am and any Team Meetings as scheduled.
6.Efficient problem solving, time management, initiative, and focus skills requiring minimum supervision and guidance.
7.High technological aptitude with efficient adaptability to diverse and changing systems and business conditions.
8.Insure key performance indicator goals are met monthly (Quality Assurance, Average Handle Time, Adherence)

Experience Qualifications

Bilingual (Spanish) a plus. Medi-Cal program and benefit requirements experience desired. HMO or Managed Care Experience preferred.

A minimum of 1-year call center experience in a customer services setting preferred. May substitute with 2 years of experience in a medical or hospitality setting.

Excellent punctuality and attendance is required.

Significant customer service experience with prior experience in handling problems and complaints with a high level of patience.

Ability to remain courteous when dealing with difficult or challenging callers is critical to this position.

Experience in learning and following standards and procedures.

Education Qualifications

Possession of a high school diploma or equivalent.

Knowledge Requirement

Ability and desire to handle 45-50 calls per day, excellent multi-tasking skills.

Positive Attitude and ability to work in a team setting.

Knowledge in Medical terminology preferable.

HealthCare Talent


Rancho Cucamonga, CA