Member Experience Vendor Specialist

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Imperial Health Plan of California, Inc. is seeking a dedicated Member Experience Vendor Specialist in Pasadena to assist members with vendor-related questions, complaints, and service issues.

You will coordinate with transportation and other vendor services, verify authorizations, and ensure timely resolution while maintaining member confidentiality. This role emphasizes clear communication and accurate record-keeping.

Qualifications

• High school diploma or equivalent.
• Experience in health plan member services, customer service, vendor coordination, or a related healthcare setting preferred.
• Strong communication, organization, problem-solving, and follow-up skills.
• Ability to handle sensitive concerns professionally, manage multiple priorities, and maintain accurate records.
• Familiarity with health plan benefits and standard office and case management systems preferred.

Responsibilities

• Serve as a point of contact for vendor-related member concerns, complaints, and service requests.
• Coordinate with transportation vendors and internal teams to verify required authorizations and address ride scheduling concerns, delays, cancellations, and other service issues.
• Assist members with access and service concerns involving fitness, vision, dental, OTC, Grocery, Flex, Reward, and other vendor benefits.
• Investigate eligibility issues and coordinate with vendors and internal departments to resolve discrepancies affecting access to benefits and services.
• Research concerns, gather relevant information, and work with the appropriate vendor or department to support timely resolution.
• Provide clear status updates and follow up on pending requests through resolution or appropriate handoff.
• Document member contacts, vendor communications, actions taken, and outcomes accurately in designated systems.
• Recognize and promptly route grievances, appeals, urgent concerns, and unresolved issues to the appropriate team under established procedures.
• Identify recurring vendor service concerns and share trends and improvement opportunities with management.
• Support department goals for timeliness, quality, productivity, and member satisfaction while protecting member confidentiality.
• Perform other related duties as assigned.

Skills

Strong communication

Organization

Problem-solving

Follow-up skills

Education

High school diploma or equivalent

Job description

Job Description

Member Experience Vendor Specialist

Department: Member Experience

Reports to: Sr. Manager Member Experience

Position Summary

The Member Experience Vendor Specialist supports members with questions, complaints, and service issues involving health plan vendors. The specialist works with members, vendors, and internal departments to coordinate services, address concerns, and follow through on outstanding issues. This role supports a positive member experience across transportation, fitness, vision, dental, OTC, Grocery, Flex, Reward, and other vendor-administered services.

Essential Duties And Responsibilities

• Serve as a point of contact for vendor-related member concerns, complaints, and service requests.
• Coordinate with transportation vendors and internal teams to verify required authorizations and address ride scheduling concerns, delays, cancellations, and other service issues.
• Assist members with access and service concerns involving fitness, vision, dental, OTC, Grocery, Flex, Reward, and other vendor benefits.
• Investigate eligibility issues and coordinate with vendors and internal departments to resolve discrepancies affecting access to benefits and services.
• Research concerns, gather relevant information, and work with the appropriate vendor or department to support timely resolution.
• Provide clear status updates and follow up on pending requests through resolution or appropriate handoff.
• Document member contacts, vendor communications, actions taken, and outcomes accurately in designated systems.
• Recognize and promptly route grievances, appeals, urgent concerns, and unresolved issues to the appropriate team under established procedures.
• Identify recurring vendor service concerns and share trends and improvement opportunities with management.
• Support department goals for timeliness, quality, productivity, and member satisfaction while protecting member confidentiality.
• Perform other related duties as assigned.

Qualifications

• High school diploma or equivalent
• Experience in health plan member services, Customer service, Vendor coordination, or a related healthcare setting preferred.
• Strong communication, organization, problem-solving, and follow-up skills.
• Ability to handle sensitive concerns professionally, manage multiple priorities, and maintain accurate records.
• Familiarity with health plan benefits and standard office and case management systems preferred.