Member Services Specialist - Community Health Group

POSITION SUMMARY

Drives customer loyalty and provides excellent telephonic customer service to our customers (members and providers). This position will work with other departments in order to respond to customer and provider concerns in a timely and effective manner.

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS and DMHC.

Requirements

RESPONSIBILITIES

• Effectively resolve member concerns through a range of strategic actions.
• Coordinating swift and seamless urgent care access, interpreter services, and transportation arrangements.
• Facilitating smooth transitions for members, encompassing changes in primary care providers and site discharges.
• Documenting all interactions meticulously by providing issue statements, steps taken for resolution, and resolution outcomes.
• Collaborating seamlessly with cross-functional departments to ensure comprehensive member care and provider/vendor support.
• Engaging with community-based programs to effectively address members' non-medical and social needs.
• Representing the company in a highly professional manner at various events and forums.
• Adhering to on-call schedules, established procedures, and consistently seeking opportunities for service enhancement.
• Playing a vital role in achieving departmental objectives, from exceptional customer service to complaint resolution and member retention.
• Exhibiting unwavering dedication to delivering superior, culturally sensitive service to team members, providers, and external partners.
• Initiating and ensuring continuity of care for members eligible for such services.
• Adhering diligently to state and local guidelines, particularly in collaboration with State and local IPA's (CSSD and CCS).
• Upholding telephone service standards by actively participating in incoming Member Services telephone lines.
• Embracing various duties and actively participating in special projects as required, be they short-term or long-term initiatives.

EDUCATION

• Bachelor's Degree

EXPERIENCE/ SKILLS

• Two years of experience in Member Services (preferably in the health care industry).
• Strong customer service background.
• Familiarity with case documentation practices.
• Experience with and sensitivity to cultural background and linguistic needs of membership.
• Familiarity and respect for special social needs of Medi-Cal populations.
• Knowledge of Medi-Cal program eligibility requirements and familiarity with services available through community based ethnic service and advocacy organizations throughout San Diego preferred.
• Familiarity with foundations and practices of public health, Medical Care Organization and Delivery.
• Understands Public Health Communications.
• Bilingual English/Spanish, English/Vietnamese, or English/Arabic.
• Excellent communication and interpersonal skills.
• Ability to exercise mature and independent judgment.
• Typing skills

PHYSICAL REQUIREMENTS

• Prolonged periods of sitting.
• Extensive use of telephone.
• Will be required to work evenings and/or weekends.

Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

PTO

Voluntary Benefits

401(k)

Pet Insurance

Gym Reimbursement