Member Relations Representative (Temp)

Prospect Medical Systems; Orange (CA); Remote; USD 40,000 - 65,000; Full time

Job summary

An established industry player in healthcare seeks a Member Relations Representative to enhance member satisfaction and retention. This role involves making outbound calls to resolve enrollment issues and ensure compliance with HIPAA standards. Ideal candidates will have a strong customer service background, excellent negotiation skills, and the ability to multitask in a fast-paced environment. Join a dedicated team that has been supporting independent physicians for over 25 years, and contribute to delivering coordinated, personalized care that promotes healthier lives.

Qualifications

• Minimum two years of customer service experience in a call center environment.
• Proficient in Microsoft Office (PowerPoint, Word, Excel).

Responsibilities

• Complete all assigned outbound retention campaigns.
• Handle inbound retention calls and track outcomes.

Skills

Customer Service

Negotiation Skills

Conflict Resolution

Multitasking

Bilingual Skills

Education

High School Diploma or GED

Bachelor's Degree

Tools

Microsoft Office

Job description

The Member Relations Representative acts as a liaison between members, health plans, and physicians. The role requires performing a minimum of 120 outbound attempts daily to Medi-Medi, Medicare, Commercial, POS, and Medi-Cal members—specifically those with enrollment errors or potential terminations—to ensure member satisfaction, wellness, and retention.

Responsibilities

Complete all assigned outbound retention campaigns.
Handle inbound retention calls.
Track outcomes of all retention efforts.
Assist with inbound member calls as needed.
Document every call thoroughly.
Verify HIPAA compliance to ensure account accuracy.
Follow up on open issues.
Report recurring issues and trends to management.

Qualifications

Minimum two years of customer service experience in a call center environment.
Two to three years of IPA/HMO experience.
Excellent customer service, negotiation, and conflict resolution skills over the phone.
Proficient in Microsoft Office (PowerPoint, Word, Excel).
Ability to multitask, prioritize, and work efficiently in a fast-paced environment.
Knowledge of IPA/HMO.
Bilingual skills preferred.
High School Diploma or GED; Bachelor's Degree preferred.

Location-based pay adjustment applies.

About Us

Prospect Medical Systems serves approximately 260,000 members with around 9,000 physicians across California, Texas, and Rhode Island. We offer extensive healthcare services, including primary and specialty care, hospital services, behavioral health, and wellness programs. Our networks leverage advanced diagnostic and treatment tools to provide state-of-the-art healthcare. For over 25 years, our mission has been to support independent physicians through risk arrangements, collaborating closely with health plans and facilities to deliver coordinated, personalized care that promotes healthier lives. We manage successful IPAs by applying best practices and results-driven administrative services under risk agreements with health plans and CMS.

Job Info

• Job Identification: 5019
• Category: Health Plans
• Posting Date: 04/28/2025, 05:08 PM
• Schedule: Full-time
• Shift: Day
• Location: 600 City Parkway West, Orange, CA, 92868, US (Remote)