Member Services Representative

CCHP Public Portal; San Francisco (CA); On-site; USD 36,203 - 54,263; Full time

Job summary

CCHP Public Portal in San Francisco seeks a Member Services Representative (MSR) to be the first point of contact for member needs. Responsibilities include resolving inquiries, educating members on health plan benefits, and providing bilingual services. Candidates should have at least 1 year of customer service experience, preferably in health care. The position starts at $26.28 hourly, with potential for higher pay based on experience and skills.

Qualifications

• Minimum 1+ years of experience in customer services or call center.
• Prior experience in health care preferred.
• Ability to handle difficult and emotional situations effectively.

Responsibilities

• Research and resolve complex member inquiries, including eligibility verification.
• Provide information on managed care and health plan benefits.
• Document all member encounters in the inquiry module.

Skills

Customer service experience

Fluency in English

Fluency in Cantonese or Spanish

Communication skills

Research and problem-solving skills

Job description

Member Services Representative (MSR) serve as the vital first point of contact for all members’ needs. A MSR functions as a “one stop” resources center; troubleshooting, providing information and providing resolution. This role is essential in delivering responsive, solution-focused service and ensuring a seamless experience for every member inquiry, issue or requests.

Essential Duties and Responsibilities

• Researches and resolves complex member inquiries and problems including, eligibility verification, benefits, referrals, authorization process and status, complaints, issues with appeals, denials, and claims questions in a timely, respectful, caring and competent manner.
• Answers telephone calls promptly and minimize delays that may lead to abandoned calls.
• Informs and educates members on managed care, health plan benefits, and operational policies and procedures and services.
• Corrects and updates basic enrollment data daily at the time of the member’s request. (PCP change, address or name change, correction, etc.)
• Provides Chinese/English language interpretation services when necessary, including assisting with arranging of medical appointments, contacting contracted PBM for prescription issues, and Durable Medical Equipment exchange/return, etc.
• Contacts providers, members and in-house departments to obtain information and resolve issues.
• Performs initial research of problem claims, pulls files, compiles necessary information and forwards to proper department for resolution.
• Documents all member/provider encounters into the Member Service Inquiry Module.
• Assists the Marketing Department with walk-in prospects by promoting CCHP and answering questions regarding the health plan.
• Alerts management of repeat phone calls due to issues that have not been resolved within standards. Recommends suggestions for improving workflow and service.
• Exercises discretion in working with confidential information.
• Accepts and performs other duties as assigned.

Qualifications

• Minimum 1+ years of experience in customer services, call center, or similar
• Prior experience in health care and knowledge of managed care of Medi-Cal preferred
• Must be fluent in English and either Cantonese or Spanish
• Excellent oral communication, customer service and organizational skills
• Thrive in a fast-paced environment while maintaining accuracy and professionalism.
• Attention to detail and willingness to exercise initiative
• Excellent decision making, research and problem-solving skills
• Ability to deal effectively with difficult and emotional people and issues.
• Display a high level of confidence and able to explain information to customers in ways that are clear, concise and objective.

Physical Requirements

• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day

Compliance Requirements

Complies with Chinese Hospital Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

Base Pay Scale

Starting at $26.28 – $39.39.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.