Member Services Representatives - Medicare (Short-Term)

About the role

As a Medicare Member Services Representative, you will serve as a devoted and compassionate advocate for Medi-Cal, Medi-Medi, and Medicare Members. Your role involves assisting members in maximizing their benefits, navigating the healthcare system, and achieving optimal health. You will use multiple complex systems to provide guidance, answer questions about benefits and medical claims, and educate members about wellness programs. Additionally, you will help members assess tools for decision-making related to their wellbeing and facilitate their access to in-network healthcare providers. Collaboration with inter-departmental teams ensures member needs are met.

This is a short-term role with a duration of up to 6 months and is not eligible for benefits. While there is a possibility this role could lead to a permanent position, it is not guaranteed and depends on business needs, performance, and other factors.

Responsibilities

• Provide guidance and answer questions from Members about their benefits and medical claims.
• Educate Members about wellness programs and assist in assessing tools for decision-making related to their wellbeing.
• Facilitate Members' selection and access to in-network healthcare providers.
• Collaborate with inter-departmental teams to ensure Member needs are met.
• Adhere to IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation.
• Handle 25-30 calls per day in a fast-paced call center environment.
• Work non-traditional hours to cover training or extended call center operations as required.

Requirements

• Internal Candidates: A minimum of twelve (12) months experience as an IEHP Member Services Representative or two (2) years of experience in a medical setting.
• External Candidates: Two (2) years of HMO or Managed Care customer service experience analyzing and solving customer problems.
• High School Diploma or GED required.
• This is a non-bilingual position; bilingual skills are highly preferred. Identified bilingual team members must pass a language proficiency assessment.

Qualifications

• Knowledge of Medicare managed care is preferred.
• Knowledge of medical terminology and Medi-Cal managed care is required.
• Understanding of and sensitivity to multi-cultural communities.
• Proficiency in Microsoft Office Suite; high capacity to multitask.
• Typing speed of 35 words per minute, proficiency in Windows applications, and experience in data entry.
• Familiarity with Cisco Finesse, Verint, HSP, and Microsoft programs.
• Excellent written and verbal communication and interpersonal skills.
• Strong organizational skills and ability to follow direction in a fast-paced environment.
• Positive attitude, team-oriented mindset, and high level of patience.
• Attention to detail and ability to work independently within specified time constraints.
• Excellent punctuality and attendance; ability to adapt to unexpected changes.

Benefits

• Competitive salary.
• State-of-the-art fitness center on-site.
• Medical insurance with dental and vision coverage.
• Life, short-term, and long-term disability options.
• Career advancement opportunities and professional development.
• Wellness programs promoting a healthy work-life balance.
• Flexible Spending Account for healthcare and childcare.
• CalPERS retirement plan.
• 457(b) option with a contribution match.
• Paid life insurance for employees.
• Pet care insurance.

Pay

$23.00 USD Hourly.