Member Services Representative (Full Time)
Location: Orange, California US
Job Number: 1337
Position Title: Member Services Representative
The Member Services Representative assists plan members with their concerns or complaints and provides the necessary information and education to resolve concerns.
(May include but are not limited to)
- Explain the plan’s procedures, protocols, benefits, services, and any other necessary information to the members who telephone or visit the Member Services Department.
- Facilitate member requests for changes with network provider changes, transportation requests, or any other member request for assistance as appropriate.
- Answer all incoming member phone calls within the department’s goal timeframe.
- Document every incoming call during the course of the call with pertinent details (i.e., caller name, contact info, reason for call, action taken, resolution, etc.,)
- Respond to complaints against the health plan and its contracted facilities by utilizing the departments Complaint/Grievance Policy and Procedure.
- Make all attempts to resolve all member disenrollment/cancellation requests, complaint/grievances, and assist the member with their questions or concerns and following up as appropriate.
- Assist with Member Outreach programs and implementations as needed.
- Foster good corporate relations by practicing good customer service principles (i.e., positive attitude, helpful, etc.).
- Perform other duties as assigned by Manager.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Education and/or Experience: High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
- Associate’s degree (A.A.) degree (preferred).
- Two years customer service/telemarketing experience.
- Medical front office experience.
- Direct sales or related experience, preferably in the Medi-Cal, Commercial, or Medicare Managed Care industry.
- Knowledge of Medi-Cal, Commercial, and Medicare Managed Care Plans.
- Bilingual (English/Spanish) required.
- Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
- Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
- Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.
- Computer Skills: Strong computer skills.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
- The employee is frequently required to walk; stand; reach with hands and arms.
- The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 20 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Location City: Orange
Location State: California
Community / Marketing Title: Member Services Representative (Full Time)
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
EEO Employer Verbiage: