Member Services Representatives - Medicare (Short-Term)

Inland-Empire-Health-Plan-; Rancho Cucamonga (CA); Hybrid; USD 26,000 - 37,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical Insurance with Dental and Vis

Life insurance

Career development

Wellness programs

Flexible Spending Account

CalPERS retirement

457(b) plan

Pet care insurance

Job summary

IEHP is seeking a Medicare Member Services Representative to assist Medi-Cal, Medi-Medi and Medicare Members by guiding benefits, navigating the system, and connecting them with in-network providers.

The role is short-term (up to 6 months) with onsite training; after training, the position may transition to telecommuting, with competitive salary and benefits as applicable.

Qualifications

• High school diploma or GED required.
• Two years of HMO/manage care customer service experience preferred.
• Knowledge of Medi-Cal managed care is preferred.

Responsibilities

• Handle Medi-Cal and Medicare inbound calls.
• Cover Cisco ACD queue lines and meet call center standards.
• Assist Members with eligibility, provider assignments, and health program education.

Skills

Medicare knowledge

Medical terminology

Microsoft Office

Typing speed 35 wpm

Multitasking

Communication skills

Interpersonal skills

Attention to detail

Education

High School Diploma or GED

Tools

Cisco Finesse

Verint

HSP

Microsoft Office

Job description

Overview

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Medicare Member Services Representative is responsible for being a devoted and compassionate advocate for Medi-Cal, Medi-Medi and Medicare Members when assisting with maximizing their benefits, navigating the healthcare system and reaching their optimal health. Using multiple complex systems, responsible for providing guidance and answering questions from Members about their benefits and medical claims, as well as educating Members about wellness programs. Assisting Members in assessing tools available to help guide decision-making about complex matters related to their wellbeing. Facilitate the Members selection and access to in-network healthcare providers. Collaborate with inter-departments to ensure Member needs are met.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

This is a short-term role with a duration of up to 6 months. Please note that this position is not eligible for benefits.

While there is a possibility that this role could lead to a permanent position, permanent employment is not guaranteed and will depend on business needs, performance, and other factors.

Additional Benefits

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary


• State of the art fitness center on-site


• Medical Insurance with Dental and Vision


• Life, short-term, and long-term disability options


• Career advancement opportunities and professional development


• Wellness programs that promote a healthy work-life balance


• Flexible Spending Account – Health Care/Childcare


• CalPERS retirement


• 457(b) option with a contribution match


• Paid life insurance for employees


• Pet care insurance

Key Responsibilities

• Handle Medi-Cal and Medicare Inbound Calls
  
  
  
  • Responsible for covering the Cisco ACD Queue telephone lines.
  
  
  • Meet IEHP and Member Services Call Center standard and policy requirements.
  
  
  • Assist Members with many different process or benefit information such as:
    
    
    
    • Members eligibility status
    
    
    • Primary care/facility assignments, selections, and changes
    
    
    • Health program education
    
    
    
    
  
  
  • Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
  
  
  • Maintain knowledge of other department’s roles as they pertain to Member Services standard work processes, to ensure proper handling of calls.
  
  
  • Ensure key performance indicator goals are met monthly (Quality Assurance, AHT, Adherence).
  
  
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.
  
  
  
  


• Off phone work
  
  
  
  • QA Review
  
  
  • One on One
  
  
  • Projects
  
  
  • Meetings
  
  
  
  


• Any other duties as required to ensure Health Plan operations are successful.


• Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.

Qualifications

Education & Requirements

• Internal Candidates:
  
  
  
  • A minimum of twelve (12) months experience as an IEHP Member Services Representative required
  
  
  • May substitute with two (2) years of experience in a medical setting
  
  
  
  


• External Candidates:
  
  
  
  • Two (2) years of HMO or Manage Care customer service experience analyzing and solving customer problems
  
  
  
  


• High School Diploma or GED required


• This is a non-bilingual: bilingual highly preferred position. Identified bilingual team members in this role must take a language proficiency assessment and must receive a passing score.

Key Qualifications

• Knowledge of Medicare managed care is preferred


• Knowledge of Medical terminology, and Medi-Cal managed care is required


• Understanding of and sensitivity to multi-cultural community.


• Proficiency in Microsoft Office Suite; high level capacity to multitask


• Excellent multi-tasking skills


• Typing 35 words per minute, proficient in Windows applications, and experience in data entry


• Knowledgeable of with the following programs: Cisco Finesse, Verint, HSP, Microsoft


• Excellent written and verbal communication and interpersonal skills


• Strong organizational skills


• Ability and willingness to learn and follow direction in a fast-paced call center environment


• Ability and desire to handle 25-30 calls per day. Adherence to specific work schedule is required


• Works well in a fast-paced environment


• Team culture a must


• Positive Attitude and ability to work in a team setting


• High level of patience


• Telephone courtesy


• Attention to detail


• Willingness and ability to learn


• Ability to work independently within specified time constraints


• Excellent punctuality and attendance required


• Ability to adapt and perform duties efficiently when unexpected changes arise


• This position will work non-traditional hours to achieve coverage during periods where training or extended call center operations are required

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location

This role will transition to telecommuting after training has been successfully completed and upon leader approval. Training will be conducted onsite, five days per week.

Pay Range

USD $23.00 - USD $23.00 /Hr.