Member Services Representative I - Bilingual Cantonese / Job Req 788843328

Alameda Alliance For Health • Alameda, CA

124d • $22 - $34 • Hybrid

About The Position

Member Services Representatives (MSR) are the first point of contact for our members' primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email, fax, letters, chat and phone calls. Timely responses to all member communication are essential. Must effectively prioritize and flex the workload as new communication and tasks are submitted. Identify the caller's needs, clarify information, research issues, and provide solutions and/or alternatives whenever possible. Accurately and consistently document all conversations in the electronic database. This position is a liaison between the plan, the provider network, and other community agencies. The MSR positions are flexibly staffed classification and work is expected to be performed minimally at the MRS II level. However, the initial selection will be made at the entry level MSR I. Our more advanced level position of the series is the MSR III who will be required to perform a variety of complex matters.

Requirements

• Bachelor's degree or equivalent experience preferred.
• High school diploma, GED required.
• The ability to speak and understand-bilingual: Spanish/English, Cantonese/English, Vietnamese/English, Tagalog/English are required as designated.
• Minimum one year of direct customer service experience.
• Experience determining eligibility for financial assistance, insurance benefits, unemployment and/or other social services programs.
• Demonstrated knowledge expert of AAH Member Services policies and procedures.
• Consistent record of meeting, maintaining, or exceeding monthly Departmental performance metrics.
• Consistent track record of documenting Service Requests accurately and clearly.
• Demonstrated proficiency in current Customer Relationship Management (CRM) tool, phone system software, and other applications.
• Demonstrated ability to effectively handle the department's key special projects.
• Demonstrated ability to help members face-to-face in the field and/or at the Alliance offices.

Nice To Haves

• Medical terminology knowledge preferred.
• Experience in use of various computer systems software as well as Microsoft Windows, and Microsoft Suite, especially Outlook, Word, Excel.

Responsibilities

• Serve as the primary contact for members, providers and others for questions related to claims, benefits, authorizations, pharmacy, member eligibility and other questions related to Alameda Alliance and provide accurate, satisfactory answers to their inquiries or concerns.
• Respond to and resolve member service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, behavioral health, and care coordination.
• Answer incoming calls, emails, chats, and other requests for assistance in a timely manner in accordance with departmental performance targets and provide excellent customer service while doing so.
• Recognize and understand the difference between calls that require quick resolutions and calls which will require follow-up and handle each appropriately.
• De-escalate situations involving dissatisfied customers, offering patient assistance and support.
• Accurately document all contacts per department standards/guidelines in the Customer Relationship Management (CRM) system.
• Accurately and consistently document and resolve Exempt Grievances.
• Interface with Grievance and Appeals, Claims, Enrollment, IT, Network Management, Pharmacy, Authorizations, and other internal departments to provide Service Excellence to our members.
• Help guide and educate members about the fundamentals and benefits of managed health care topics.
• Intercede with care providers on behalf of the member, assisting with appointment scheduling.
• Assist members in navigating alamedaalliance.org, the Member Portal, and other health care partner online resources.
• Manage any issues through to resolution on behalf of the member.
• Research complex issues across multiple databases and work with support resources to resolve member issues.
• Provide education and status on previously submitted pre-authorizations or pre-determination requests.
• Meet the performance goals established for the position in the areas of compliance, efficiency, call quality, member satisfaction, first call resolution, punctuality, and attendance.
• Always maintain a professional level of service to members.
• Always maintain confidentiality of information.
• Consistently support the Alliance's approach to Service Excellence by adhering to established department and company standards for all work-related functions.
• Interact positively with all Alliance Departments.
• Process MS Dept projects.
• Serve as a back-up to manage the escalated calls.
• Perform other duties as assigned.

Benefits

• Salary range $22.88-$34.33 hourly.
• Equal opportunity employer.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: High school or GED
• Number of Employees: 251-500 employees