The Member Service Representative (MSR) is the first line of contact for HealthSmart MSO’s Client’s members and providers. The member services representative will assist members and providers with questions related to the Medi-Cal, Commercial, Covered California, Medicare and D-SNP programs for Orange and Los Angeles County’s. The incumbent will resolve member inquiries and complaints fairly and effectively. The incumbent will provide information regarding eligibility, enrollment, benefits and services to our Client’s eligible members and providers.

Duties and Responsibilities:

• Achieves high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the member services team in completing department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
• Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care telephonically.
• Communicates, builds and maintains internal and external relationships by prompt and accurate service.
• Identifies and communicates challenges that might arise with the use of professional judgement while adhering to departmental policies and procedures.
• Follows through on and completes all member and provider inquiries or requests.
• Enters accurate, complete and correct documentation into EHealthcare system regarding all issues and/or inquires, complaints and grievances.
• Serves as a resource for other team members.
• Functions efficiently and productively in a high-volume telephone ACD-Line recorded call center.
• Maintains departmental productivity and quality standards.
• Investigate, address and resolve member eligibility discrepancies.
• Mail Health Plan(s) Eligibility rosters and IPA’s Correspondences to PCP’s.
• Verify, edit and add member eligibility in EHealthCare System.
• Prepare monthly mailings of capitation checks and rosters.
• Completes other projects and duties as assigned.

Experience & Education:

• High School diploma or equivalent required.
• 6 months of customer service experience required.
• Bilingual in English and in one of DHCS’s defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) preferred.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Health Maintenance Organization (HMO), Medi-Cal, Commercial/Covered CA, Medicare and D-SNP and/or health services experience.
• 3-6 months of call center experience.
• Typing speed of 40 words per minute (WPM).

Physical Demands and Work Environment:

The physical demands and work environment characteristics 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.

• Physical demands: While performing duties of job, employee is required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms. Employee must be able to talk and hear, particularly for regular communication on the phone.
• Work Environment: Moderate noise levels due to call center operations. Frequent interruptions are common. Office temperatures are controlled and comfortable.

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

Job Type: Full-time

Pay: $20.00 - $25.03 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience level:

• Under 1 year

Shift:

• 8 hour shift
• Day shift

Weekly day range:

• Monday to Friday

Work setting:

• In-person
• Office

Ability to commute/relocate:

• Cypress, CA 90630: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Call Center: 1 year (Preferred)
• Customer service: 1 year (Preferred)
• Health Care: 1 year (Required)

Work Location: In person