- Direct Placement
- Customer Service
- Rancho Cucamonga, CA
Member Services Representative; Medi-Cal
Rancho Cucamonga, CA
Under the direction of the Call Center Member Services Supervisor, will anticipate, document and respond to Members' needs and represent the health plan in a friendly and professional manner. The MSR I will work in concert with other departmental Team Members to achieve 5 Star Service and call center goals.
- Provide Member's with health plan education in regards to and Medi-Cal benefit coverage, including understanding coordination of benefits and eligibility rules.
- Meet COMPANY and Member Services Call Center standard and policy requirements. This includes, but is not limited to the following; successful completion of Member Services Training, active participation in continuous training, use telephone system and other COMPANY equipment appropriately and for professional reasons only, follow required call scripts and adhere to Attendance/Punctuality and Dress Code policy.
- Provide superior service that delights caller in all aspects of the interaction including:
- Strive to assist caller on the first point of contact. Demonstrate a high level of patience and respect; avoid distractions to ensure each caller is assisted promptly and appropriately; follow call handle standards and objectives.
- Assist with Member primary care/facility assignments, selections and changes; health care options liaison; health education advisory; supply eligibility status of Members to providers
- Member education including tagging, material request, programs, ordering ID cards and accessing services.
- When necessary present cases to Member Services Management Team and work with other departments to resolve Member and/or Provider inquiries and/or issues. Including but not limited to transportation requests, interpreter requests, referrals questions/concerns, re-directions, Behavioral Health and Pharmacy inquiries.
- Document accurately while speaking with the caller. Complete Member Satisfaction Surveys and Assessments, as needed. Over 100% call documentation is required
- f. Proper and timely intake of Member grievances
- Coordinate telephonic translation of calls when Members do not speak English or Spanish.
- Participate in Member Services Department meeting, which are held approximately twice a month on a Wednesday from 7:00am to 8:00am. In addition, responsible for attending monthly TQM which are conducted from 7:00am to 8:00am and any Team Meetings as scheduled.
- Efficient problem solving, time management, initiative, and focus skills requiring minimum supervision and guidance.
- High technological aptitude with efficient adaptability to diverse and changing systems and business conditions.
- Ensure key performance indicator goals are met monthly (Quality Assurance, Average Handle Time, Adherence)
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in COMPANY's policies and procedures relating to HIPAA compliance. Demonstrate a commitment to understand and adhere to the Regulatory requirements as they relate to the business unit.
- Preserve Member's confidentiality by authenticating callers (submitting guardianship documents for verification, establish guardianship alerts, authentication passwords and confidentiality alerts as needed).
- Demonstrate a commitment to LEAN by participating in process improvement projects and RIE Events/Huddles. Act as an owner and submit ideas on efficiency gains.
- Assist Members with navigation, troubleshooting and password reset with COMPANY Website and Web Portal.
- Assist with tracking trends within the department and escalating this information to management.
- Ensure timely work action on all Activities and Cases. Submit daily updates on aged Activities or Cases to management.
- Review call monitors recordings and develop self-action plans to improve quality assurance scores.
- Maintain knowledge of other departments and the roles they play in Member Services standard work processes, to ensure proper handling and tasking of calls.
- Comply with COMPANY Telecommuting Agreement and requirements, as applicable.
- Any other duties as required to ensure Health Plan operations are successful
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in COMPANY's policies and procedures relating to HIPAA compliance.
- Possession of a high school diploma or equivalent.
- Bilingual (Spanish) a plus.
- Medi-Cal program and benefit requirements experience desired. HMO or Managed Care Experience preferred.
- A minimum of 1 year call center experience in healthcare customer services setting required.
- May substitute with 2 years of experience in a medical or hospitality setting.
- Significant customer service experience with prior experience in handling problems and complaints with a high level of patience. Ability to remain courteous when dealing with difficult or challenging callers is critical to this position.
- Experience in learning and following standards and procedures.
- Microsoft Windows applications experience.
- Candidate must feel comfortable with learning and using computer programs.
- Typing- Minimum 35 wpm, good grammar and spelling skills are necessary.
- Excellent punctuality and attendance is required.
- Significant customer service experience with prior experience in handling problems and complaints with a high level of patience.
- Ability to remain courteous when dealing with difficult or challenging callers is critical to this position. Experience in learning and following standards and procedures.
- Ability and desire to handle 45-50 calls per day, excellent multi-tasking skills. Positive Attitude and ability to work in a team setting.
COMPENSATION | POSITION CLASSIFICATION
- Opportunity for $1/hr additional stipend for Bi-Lingual (Spanish) candidates
- Full Time, Benefited – Direct Hire