Member Services Specialist

Requisition #20339
Employment Type

Temporary

Experience

Two Years Health Plan environment

Required Degree

Associates Degree

Location

445 Grant Avenue, San Francisco, CA 94108

Region
Bay Area San Francisco
Application Email
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POSITION SUMMARY

Member Services Specialists are the primary point of contact for member inquiries, issues and requests. Service is primarily conducted by telephone, but also includes serving walk-in customers to the Member Services Department.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Researches and resolves complex member inquiries and problems including, eligibility verification, benefits, referrals, authorization process and status, complaints, issues with appeals, denials, and claims questions in a timely, respectful, caring and competent manner.
  • Answers telephone calls promptly and minimizes delays that may lead to abandoned calls.
  • Informs and educates members on managed care, health plan benefits, and operational policies and procedures and services.
  • Corrects and updates basic enrollment data daily at the time of the member’s request. (PCP change, address or name change, correction, etc.)
  • Provides Chinese/English language interpretation services when necessary, including assisting with arranging of medical appointments, contacting contracted PBM for prescription issues, and DME exchange/return, etc.
  • Contacts providers, members and in-house departments to obtain information and resolve issues.
  • Performs initial research of problem claims, pulls files, compiles necessary information and forwards to proper department for resolution.
  • Documents all member/provider encounters into the Member Service Inquiry Module.
  • Assists the Marketing Department with walk-in prospects by promoting CCHP and answering questions regarding the health plan.
  • Alerts management of repeat phone calls due to issues that have not been resolved within standards. Recommends suggestions for improving workflow and service.
  • Exercises discretion in working with confidential information.
  • Member Services Specialist is under mandatory requirement to work in assigned CCHP office locations and take turns to work on rotation scheduled shifts.
  • Accepts and performs other duties as assigned.

QUALIFICATIONS

  • Associate degree preferred
  • Minimum 1+ years of experience in customer services, call center, or similar
  • Prior experience in health care and knowledge of managed care of Medi-Cal preferred
  • Strong PC skills
  • fluency in English and Cantonese
  • Excellent oral communication, customer service and organizational skills
  • Ability to work under pressure in a busy call center environment
  • Attention to detail and willingness to exercise initiative
  • Excellent decision making, research and problem solving skills
  • Ability to deal effectively with difficult and emotional people and issues.
  • Display a high level of confidence and able to explain information to customers in ways that are clear, concise and objective.

PHYSICAL REQUIREMENTS

  • Able to lift up to 30 pounds
  • Use proper body mechanics when handling equipment
  • Standing, walking and moving 50% of the day.