Member Services Representative 23-01244 - Alura Workforce Solutions
San Bernardino, CA 91730
About the Job
Position
Member Services Representative- Medicare
Description
Member Services Representative - Medicare is responsible for being a devoted and compassionate advocate for Medi-Cal, Medi-Medi and Medicare Members when assisting with maximizing their benefits, navigating the healthcare system, and reaching their optimal health. Using multiple complex systems, responsible for providing guidance and answering questions from Members about their benefits and medical claims, as well as educating Members about wellness programs. Assisting Members in accessing tools available to help guide decision-making about complex matters related to their wellbeing. Facilitate the Members selection and access to in-network healthcare providers. Collaborate with inter-departments to ensure Member needs are met.
This is a Bilingual (English/Spanish) position. The Team Member in this role must take a language proficiency assessment and must receive a passing score.
1. Handle Medi-Cal and Medicare Inbound Calls
a. Responsible for covering the Cisco ACD Queue telephone lines.
b. Meet company and Member Services Call Center standard and policy requirements.
c. Assist Members with many different process or benefit information such as:
i. Members eligibility status
ii. Primary care/facility assignments, selections, and changes
iii. Health program education
d. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards
e. Maintain knowledge of other department's roles as they pertain to Member Services standard work processes, to ensure proper handling of calls
f. Ensure key performance indicator goals are met monthly (Quality Assurance, AHT, Adherence).
g. Coordinate telephonic translation of calls when Members do not speak English or Spanish
2. Off phone work
a. QA Review
b. One on One
c. Projects
d. Meetings
Requirements
Member Services Representative- Medicare
Description
Member Services Representative - Medicare is responsible for being a devoted and compassionate advocate for Medi-Cal, Medi-Medi and Medicare Members when assisting with maximizing their benefits, navigating the healthcare system, and reaching their optimal health. Using multiple complex systems, responsible for providing guidance and answering questions from Members about their benefits and medical claims, as well as educating Members about wellness programs. Assisting Members in accessing tools available to help guide decision-making about complex matters related to their wellbeing. Facilitate the Members selection and access to in-network healthcare providers. Collaborate with inter-departments to ensure Member needs are met.
This is a Bilingual (English/Spanish) position. The Team Member in this role must take a language proficiency assessment and must receive a passing score.
1. Handle Medi-Cal and Medicare Inbound Calls
a. Responsible for covering the Cisco ACD Queue telephone lines.
b. Meet company and Member Services Call Center standard and policy requirements.
c. Assist Members with many different process or benefit information such as:
i. Members eligibility status
ii. Primary care/facility assignments, selections, and changes
iii. Health program education
d. Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards
e. Maintain knowledge of other department's roles as they pertain to Member Services standard work processes, to ensure proper handling of calls
f. Ensure key performance indicator goals are met monthly (Quality Assurance, AHT, Adherence).
g. Coordinate telephonic translation of calls when Members do not speak English or Spanish
2. Off phone work
a. QA Review
b. One on One
c. Projects
d. Meetings
Requirements
- A minimum of twelve (12) months experience as a Member Services Representative required. May substitute with two (2) years of experience in a medical setting.
- Two (2) years of HMO or Manage Care customer service experience analyzing and solving customer problems.
- Must be bilingual Spanish
- High school diploma or GED required.
- Knowledge of Medicare managed care is preferred. Knowledge of Medical terminology, and Medi-Cal managed care is required.
Source : Alura Workforce Solutions
