Member Services Representative

AIDS Healthcare Foundation • Los Angeles, CA

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About The Position

A Member Services Representative contributes to AHF by connecting his/her dialy activities to the organization’s mission and core values by providing a positive experience to members, properctive members, providers and internal staff.
A Member Services Representative enhances the reputation of AHF by adherence and actively practicing teamwork, collaboration, and advocacy for our members. Responsible for efficiently managing member services, they strive to provide exceptional support to ensure high levels of member satisfaction. This includes tasks such as processing PHP and PHC enrollments, effectively operating the call center by promptly answering member and provider calls, maintaining up-to-date knowledge of PHP and PHC health plan benefits and eligibility, as well as providing and ensuring accuracy of member benefit information. In addition, the member services representative handles complaint and grievance management with empathy and professionalism, resolving issues in a timely manner. They ensure that all materials, such as enrollment packets and benefit information, are delivered to members promptly. Furthermore, they provide updates on claims to providers, keeping them informed about claim status. It is also important for the representative to stay current on regulatory compliance metrics for CMS/DHCS and DMHC requirements, ensuring all member services practices adhere to regulatory standards. Additional duties may include providing pharmacy technical support and assisting with other tasks as needed to support the overall functions of the Member Services department.
You will be a passionate advocate for our top initiatives.
To be successful as a Member Services Representative it is crucial to ensure that the AHF Core Values and Mission stay top of mind with all that you do. At AHF we are nimble and able to adapt in a dynamic environment to assist in providing the best experience for our clients and workplace for our employees.
AHF has a collaborative organizational structure where staff are accountable to multiple leaders.
The Member Services Representative will work as a part of a close-knit team to description
AHF Commitment
We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment. AHF will consider qualified applicants with criminal histories in a manner consistent with the requirements of the ordinance.

Responsibilities

• providing a positive experience to members, properctive members, providers and internal staff
• adherence and actively practicing teamwork, collaboration, and advocacy for our members
• efficiently managing member services
• processing PHP and PHC enrollments
• effectively operating the call center by promptly answering member and provider calls
• maintaining up-to-date knowledge of PHP and PHC health plan benefits and eligibility
• providing and ensuring accuracy of member benefit information
• handling complaint and grievance management with empathy and professionalism, resolving issues in a timely manner
• ensuring that all materials, such as enrollment packets and benefit information, are delivered to members promptly
• providing updates on claims to providers, keeping them informed about claim status
• staying current on regulatory compliance metrics for CMS/DHCS and DMHC requirements, ensuring all member services practices adhere to regulatory standards
• providing pharmacy technical support and assisting with other tasks as needed to support the overall functions of the Member Services department

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed