Member Services Representative jobs in San Francisco, CA
Member Services Representative addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care. Responsible for receiving, responding to, and directing member phone calls, or written questions. Being a Member Services Representative provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Member Services Representative works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Member Services Representative typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Recently Added Member Services Representative jobs
Member Services Representative
- CCHP Health Plan
-
San Francisco, CA
FULL_TIME
-
Requisition #
20383
Location
San Francisco Bay AreaEmployment Type
TemporaryPosition Summary
The Member Services Representative is 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 & 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 plan experience 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.
Compliance requirements
Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.Base Pay Scale
Starting at $21.56-$32.31/hourThe salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage. - 1 Month Ago
Member Services Representative I - Bilingual Tagalog
- Health Plan of San Mateo
-
South San Francisco, CA
FULL_TIME
- Do you speak English and Tagalog fluently? You can help HSPM members with limited English proficiency get the most out of their health care benefits by joining our Member Services team! You’ll provide...
- 6 Days Ago
Member Services Representative I - Bilingual Spanish
- Health Plan of San Mateo
-
South San Francisco, CA
FULL_TIME
- Do you speak English and Spanish fluently? You can help HSPM members with limited English proficiency get the most out of their health care benefits by joining our Member Services team! You’ll provide...
- 6 Days Ago
Member Services Representative I - Bilingual Spanish (Hybrid)
- Health Plan of San Mateo
-
South San Francisco, CA
FULL_TIME
- Must speak Spanish Full-time position with generous benefits Hybrid On-Site Make a real difference in people’s lives by helping them get health care – all while working from home. As a Member Services...
- 1 Month Ago
Member Services Social Worker
- North East Medical Services
-
San Francisco, CA
FULL_TIME
- The Member Services Social Worker I carries out eligibility screening for clients and prospective clients on a regular basis; conducts psychosocial assessments, assesses the health and related needs o...
- 3 Days Ago
Financial Services Representative
- Monterra Credit Union
-
San Mateo, CA
FULL_TIME
- Do you possess a broad knowledge of financial products and services?Would you like to work at a collaborative organization that thrives on providing outstanding member service both internally and exte...
- 14 Days Ago
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0 Member Services Representative jobs found in San Francisco, CA area
About San Francisco, California
San Francisco is located on the West Coast of the United States at the north end of the San Francisco Peninsula and includes significant stretches of the Pacific Ocean and San Francisco Bay within its boundaries. Several picturesque islands—Alcatraz, Treasure Island and the adjacent Yerba Buena Island, and small portions of Alameda Island, Red Rock Island, and Angel Island—are part of the city. Also included are the uninhabited Farallon Islands, 27 miles (43 km) offshore in the Pacific Ocean. The mainland within the city limits roughly forms a "seven-by-seven-mile square", a common local collo...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Member Services Representative jobs
$44,621 to $54,150
San Francisco, California area prices
were up 4.5% from a year ago
were up 4.5% from a year ago