Member & Provider Support Specialist

Independent Living Systems, llc; San Francisco (CA); Presencial; USD 40 000 - 55 000; Tempo integral

Resumo da oferta

Independent Living Systems (ILS) is seeking a Member & Provider Services Representative to act as the primary contact for members, providers, and internal teams in a mission-driven environment focused on quality of life and independence. The role supports Florida Community Care and Florida Complete Care programs by delivering compassionate, accurate information and timely assistance.

You will handle high-volume calls, assist with scheduling, educate members and providers, document interactions,

Qualificações

• High School Diploma or GED.
• Proven experience working in healthcare or a related field.
• Ability to manage high-volume contact center demands.
• Familiarity with inbound and outbound customer service processes and phone systems.
• Basic clerical experience and data entry/record keeping.
• Ability to work flexible hours to accommodate contact center shifts.
• Strong interpersonal and communication skills with diverse populations.
• Knowledge of healthcare terminology and HIPAA privacy regulations.
• Certification in customer service or contact center operations is a plus.

Responsabilidades

• Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
• Handle a high-volume of inbound and/or outbound calls, providing accurate information on healthcare services, scheduling, and member and provider inquiries in a professional, courteous, compassionate and empathetic manner.
• Use active listening to identify needs, resolve concerns, educate members and providers, and strive for first call resolution whenever possible.
• Conduct comprehensive reviews of member and provider inquiries, complaints, grievances, and escalated issues by gathering information, obtaining documentation, clarifying circumstances, and facilitating timely resolution.
• Coordinate with internal departments, providers, and other stakeholders to resolve issues, support follow-up needs and elevate concerns when appropriate.
• Manage a high-volume caseload while meeting productivity expectations, service level agreements, regulatory turnaround requirements, and quality standards.
• Accurately document call details, update member records, and utilize contact center systems and clerical tools in accordance with established procedures.
• Ensure compliance with healthcare regulations, service level agreements, organizational policies, and confidentiality standards in all communications.
• Maintain established standards for schedule adherence, attendance, quality, member and provider satisfaction, and performance (including average handle time, after call work time, and outreach targets).
• Demonstrate professionalism through reliability, teamwork, strong work ethic, initiative, organization, and ongoing participation in training and professional development.
• Perform other duties as assigned.

Conhecimentos

High School Diploma or GED

Healthcare experience

High-volume contact center

Inbound/outbound customer service

Data entry and record keeping

Flexible hours

Interpersonal and communication skills

HIPAA knowledge

Certification in customer service

Microsoft Office Suite

Formação académica

Associate's degree

Ferramentas

Microsoft Office Suite

Descrição da oferta de emprego

Independent Living Systems (ILS) is seeking a Member & Provider Services Representative to act as the primary contact for members, providers, and internal teams in a mission-driven environment focused on quality of life and independence. The role supports Florida Community Care and Florida Complete Care programs by delivering compassionate, accurate information and timely assistance.

You will handle high-volume calls, assist with scheduling, educate members and providers, document interactions,