Member Services Rep

CommonSpirit Health; Rancho Cordova (CA); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Dignity Health Medical Foundation in California is seeking a Member Services Representative to provide exceptional service to patients, insurers, and physicians in line with our policies.

You will address questions on eligibility and benefits, PCP assignments, authorizations, and Out of Group claims, while guiding calls to the right resources. Training starts onsite, after which the role can be performed from home in the Greater Sacramento region.

Qualifications

• 1 year of related experience (office, insurance services, customer service)
• High School diploma or GED is required
• PC-based software skills (e.g. Windows, Word, Outlook)
• Effective communication, written and verbal
• Strong interpersonal and customer service abilities
• Ability to navigate and document in information systems

Responsibilities

• Serve as a primary contact for patients, insurers, and physicians
• Answer questions on eligibility, benefits, PCP assignments, and authorizations
• Direct calls to the appropriate resources
• Demonstrate outstanding customer service, listening, and problem-solving skills
• Support quality and performance improvement initiatives
• Demonstrate dependability and reliability

Skills

Customer service

Communication

Interpersonal skills

Documentation skills

Education

High School diploma or GED

Tools

Microsoft Windows

Microsoft Outlook

Microsoft Word

Job description

Job Summary and Responsibilities

As our Member Services Representative, you will contribute to the mission and vision of our organization by providing exceptional customer service to patients, health insurance companies, and physicians and their staff, in a manner consistent with our established policies and beliefs.

Every day you will serve as a primary point of contact, interacting directly with individuals seeking information, assistance, or access to services. You will be responsible for addressing diverse questions concerning member eligibility and benefits, Primary Care Physician (PCP) assignments, Managed Care authorizations, and Out of Group claims, as well as helping to direct any other miscellaneous calls to the correct resources.

To be successful in this role, you will demonstrate outstanding customer service capabilities, including strong active listening, clear verbal communication, and problem-solving skills.

This position will be work from home in the Greater Sacramento region once the initial onsite onboarding and training has completed.

• Proactively support quality & performance improvement efforts within the organization.
• Demonstrates understanding and appropriate utilization of resources (i.e. materials, financial, etc.).
• Demonstrates ability to appropriately plan and prioritize work.
• Demonstrates effective and professional interpersonal skills.
• Proactively contribute to meeting department and organizational goals.
• Demonstrate dependability and reliability.

Job Requirements

Required

• One (1) year of related experience (i.e. office experience, insurance services, customer service, etc.)
• High School diploma or GED
• PC based computer software (e.g. Microsoft Windows, Work and Outlook)
• Effective communication skills both orally and in writing
• Demonstrated skill in working with a wide range of customers while maintaining accurate system documentation
• Excellent interpersonal and customer service skills
• Ability to navigate and utilize information system

Preferred

• One (1) year of related experience in the healthcare industry strongly preferred
• Experience in a high-volume contact/call center environment strongly preferred
• Experience with claims or invoice process (adjudication) is strongly preferred
• Knowledge and understanding of how HMO/Managed Care works preferred
• Experience with, or a good understanding of, Member Out of Pocket Max (MOOP) and Member Deductible preferred
• Experience with, or a good understanding of, Division of Financial Responsibility (DOFR) preferred

Where You’ll Work

Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.