To respond to member and provider calls regarding Plan policies, procedures, membership, eligibility, benefits, and claims, providing the highest level of customer service. In addition to the Member Services Representative duties, the Lead Member Services Representative has a higher level of experience, monitors call queues, assists with training material, and handles complex calls that cannot be resolved by the Member Services Representatives.
Education and Experience | High school diploma or equivalent; minimum three (3) years of experience in a managed care or member services environment preferred; or equivalent combination of education and experience.
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Special Skills, Licenses and Certifications | Thorough working knowledge of managed care and member services policies and procedures. Excellent understanding of all PHC policies and procedures relating to all aspects of care. Excellent understanding of external agencies that provide services to PHC members. Basic understanding about the Medi-Cal eligibility process. Working knowledge of business software applications. Proficient use of computer keyboard to access data. Bilingual skills in Spanish, Tagalog, or Russian are preferred.
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Performance Based Competencies | Good oral and written communication skills. Excellent customer service skills with ability to assess and resolve customer complaints, problems, and issues in an efficient and effective manner. Excellent organization skills with ability to prioritize issues, use good judgment, and handle sensitive issues with tact and diplomacy.
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Work Environment And Physical Demands | Ability to use a computer keyboard. More than 80% of work time is spent talking on the telephone and using a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 25 lbs. |
All HealthPlan employees are expected to:
HIRING RANGE:
$32.51 - $39.01
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
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