|Interested? Email Us||Never Applied? Apply|
|Member Services Representative - Remote|
|Hours:||40 Monday to Friday 8AM to 5PM|
|Great opportunity in Camarillo CA|
Will assist members by providing professional, accurate and timely responses to inquiries regarding enrollment, eligibility, plan benefits, provider network,, authorizations, plan guidelines and processes. The Member Services Representative, will respond to inquiries received from members via walk-in, telephone call or email. The Member Services Representative, will also respond to requests for assistance from other internal departments and external partners.ESSENTIAL FUNCTIONSExplains company procedures, protocols, benefits, services and information to members as required.Provides accurate information about eligibility, benefits and claim status and authorization requirements to serve members ina courteous and professional manner.Functions efficiently and productively in all required duties.Interacts face-to-face with members by assisting with front desk coverage.Handles and resolves escalated issues.Maintains an up-to-date and thorough knowledge of company guidelines.Provides accurate research to resolve issues regarding eligibility, benefits, claims and authorizations using appropriate systems.Properly documents all callscontacts as required by department standards in a timely, clear and concise manner using companysinternal tracking system.Provides assistance with member oriented events.Reviews trainingeducational material and seek clarification when needed.Provides assistance with member oriented events.Maintains strict confidentiality of all sensitive information.Refers unresolved issues to the next level andor appropriate area when necessary.Achieves and maintain acceptable performance levels according to the Member Service standards.Utilizes documents using Microsoft Office and other applicable software, as designated by management.Performs general clerical duties to include but not limited to photocopying, faxing, mailing, and filing.Processes member ID card requests and performs other Member Services related tasks, functions and special projects.
HSGED. 2 plus years of experience in Customer Service. MS Office. Bilingual in EnglishSpanish.
Call center experience a plus.Preferred experience in the health care field interacting directly with members.Direct experience with Medi-Cal guidelines and health insurance rules and regulations a plus.