Member Services Representative, Sr. jobs in San Francisco, CA
Member Services Representative, Sr. addresses more complex health plan or HMO 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 and written requests. Being a Member Services Representative, Sr. provides available information upon request and researches or escalates issues as appropriate. Maintains confidentiality per HIPAA guidelines. Additionally, Member Services Representative, Sr. requires a high school diploma or equivalent. Typically reports to a supervisor or manager. The Member Services Representative, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Member Services Representative, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
Recently Added Member Services Representative, Sr. 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 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...
- 4 Days 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...
- 4 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...
- 1 Day Ago
Sr Director Professional Services
- Freshworks
-
San Mateo, CA
FULL_TIME
- Job Description About the team - The NA professional services team : is a diverse group of dedicated and passionate professionals consisting of Solution Architects, Technical Architects, Engagement Ma...
- 9 Days Ago
Filters
- Current Active Filter
- San Francisco, CA
Clear All
- Filter Jobs By posted time
- Within 1 Day
- Within 2-7
- Within 1 Month
- Within 3 Months
0 Member Services Representative, Sr. jobs found in San Francisco, CA area
Member Service Representative
- SHELL WESTERN STATES FEDERAL CREDIT UNION
-
Martinez, CA
- Shell Western States Federal Credit Union is seeking a Member Service Representative to join a well-established Credit U...
- 4/17/2024 12:00:00 AM
Member Services Representative
- Crunch
-
San Lorenzo, CA
- Reports to: Manager Requirements: Fluent in English Proficient reading and writing skills Computer Skills Special Skills...
- 4/17/2024 12:00:00 AM
Member Services Representative
- Crunch
-
Fairfield, CA
- Reports to: Manager Requirements: Fluent in English Proficient reading and writing skills Computer Skills Special Skills...
- 4/17/2024 12:00:00 AM
Bilingual Member Service Associate
- Redwood Credit Union
-
San Rafael, CA
- At Redwood Credit Union we are on a journey to reimagine the way we do business, and we can't do it without you - our ne...
- 4/17/2024 12:00:00 AM
Universal Member Service Representative
- Self Help
-
Pittsburg, CA
- ** Universal Member Service Representative** **Job Category****:** Branch **Requisition Number****:** UNIVE001856 Showin...
- 4/16/2024 12:00:00 AM
Member Services Rep
- YMCA
-
Berkeley, CA
- We are seeking staff for our dynamic fitness branch membership team! Our fitness centers are community hubs where people...
- 4/15/2024 12:00:00 AM
Member Service Representative
- Exos Partners, LLC
-
San Francisco, CA
- EXOS is a leader in the field of human performance, a category it created more than 20 years ago. For two decades weve s...
- 4/14/2024 12:00:00 AM
Member Service Representative - Part Time - Pinole
- Taymax Group
-
Pinole, CA
- Pinole 1570 Fitzgerald Dr, Pinole, CA 94564, United States of America Pay : $16.00 - $16.50 It's fun to work in a compan...
- 4/14/2024 12:00:00 AM
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, Sr. jobs
$59,423 to $74,351
San Francisco, California area prices
were up 4.5% from a year ago
were up 4.5% from a year ago
What does a Member Services Representative, Sr. do?
Member Services Representative, Sr. in Memphis, TN
The Member Service Representative (MSR) provides a high standard of financial service to existing and potential members, processing transactions and building relationships while promoting the products and services of the credit union.
December 24, 2019
Member Services Representative, Sr. in Manchester, NH
Customer Service Representatives interface with customers via inbound calls and/or the Internet for the purpose of resolving routine problems with products or services, specifically insurance plans.
February 13, 2020
Delivers best service possible to members when they have requests or queries, always looking for ways to improve our service to them.
January 15, 2020
Member Services Representative, Sr. in Killeen, TX
Provides such member services as opening new accounts, ordering checks, ATM maintenance, corrections, etc.
February 23, 2020