Member Services Representative I

KHS•Bakersfield, CA

2d•$23 - $29

About The Position

Under the supervision of the Member Services Supervisor and the direction of the Member Services Manager, the Member Services Representative will perform new member welcome calls and respond to inquiries from members and providers regarding Plan benefits, Plan policies, Member Portal, claims issues and facilitate appropriate resolutions. The incumbent will have daily and extensive contact with members and service providers to resolve complex issues, interpret policies/procedures, explain benefits, respond to requests for service, survey members and solve problems.

Requirements

High School Diploma from an accredited school or equivalent.
Two (2) or more years of recent experience in a customer service organization or related field with a high degree of problem solving and decision making. Strong telephone and communication skills required.
Typing skills of 30+ NWPM; Required.

Responsibilities

Strive to practice KHS’ Mission, Vision and Values (MVV) every day, and strongly commit to advance the organization’s strategic plan.
Provide the best customer service and member advocacy that reflects KHS’ MVV.
Work directly with members and service providers to identify and resolve health care service concerns.
Acts as the member advocate promoting timely complaint and problem resolution, while representing Kern Health Systems with every interaction.
Responsible for timely, detailed and accurate responses to member inquiries. Assists with the processing of complaints and grievances in accordance with the health plan’s grievance policies and procedures and regulatory agency requirements.
Responds to time critical questions with detailed and expeditious follow-up to promote accurate and timely processing of issues.
Employs effective communication methods to promote positive and productive public relations with members, providers and other departments.
Identifies, investigates, resolves, and reports member/provider issues to management.
Promotes high standards of member satisfaction and access to medical care by documenting feedback from members. Any deviations from established standards are documented in QNXT and reported to management for evaluation.
Prepares reports and submits results through the established administrative channels.
Maintains an effective, efficient and confidential filing and tracking system to facilitate easy retrieval of contact information while maintaining confidentiality in accordance with established policies and regulations.
Documents all interactions with members and providers by appropriately coding and logging information in QNXT.
Answers phones in a specified time frame, while maintaining a high quality of service for the members and providers.
Responsible for Member Retention efforts which may include but are not limited to telephone surveys conducted to monitor member satisfaction.
Assembles and provides current Plan information requested by members ensuring that the information is accurate.
Responsible for assisting the Member Services Trainer with training new Member Services Representatives as they are hired.
Assist members, providers or other KHS Departments with scheduling medical appointments and assisting with scheduling transportation needs for members.
Assists management staff in completing member services related special projects.
Organizes and maintains departmental files, records, handbooks and manuals.
Utilizes personal computer for detailed data analysis, report generation, documentation and project evaluation purposes.
Performs other job-related duties as required.
Adheres to all company policies and procedures relative to employment and job responsibilities.