Kaiser Permanente-posted about 1 year ago
Full-time • Entry Level
San Marcos, CA
Ambulatory Health Care Services

The Healthplan Representative at Kaiser Permanente is responsible for educating providers, staff, and members about Health Plan benefits and services, while ensuring compliance with applicable regulations. This role involves investigating and processing member inquiries, resolving complaints and grievances, and collaborating with various departments to enhance member experiences. The representative acts as a liaison between members and the organization, promoting effective communication and service solutions.

  • Educate providers, staff, and members on Health Plan benefits and services.
  • Investigate and process member inquiries and complaints in a timely manner.
  • Act as a liaison between patients/members and Kaiser Permanente.
  • Partner with other departments to provide accurate information about KP services.
  • Research and resolve Health Plan coverage-related issues for members.
  • Document and triage case information to the Member Case Resolution Center.
  • Communicate with members regarding the Health Plan's response to grievances.
  • Ensure compliance with regulatory standards and internal policies.
  • Participate in departmental meetings, trainings, and audits as requested.
  • Assist non-English speaking customers with interpreter services.
  • Minimum one year of experience in a customer service environment.
  • High School Diploma or GED required.
  • Strong working knowledge of federal and state regulations related to health care.
  • Demonstrated ability to handle high volumes of customer contact.
  • Strong understanding of health plan terminology.
  • Ability to interview and investigate emotional situations sensitively.
  • Excellent interpersonal and verbal communication skills.
  • Demonstrated conflict resolution and mediation skills.
  • Customer service training preferred.
  • Knowledge of member complaint and grievance processing preferred.
  • Bilingual skills preferred.
  • Bachelor's degree preferred.
  • Health insurance coverage
  • 401k retirement savings plan
  • Paid holidays
  • Flexible scheduling
  • Professional development opportunities
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