Member Services Representatives - Medicare (Short-Term)

Inland Empire Health Plan•Rancho Cucamonga, CA

11d•$23 - $23•Hybrid

About The Position

This is a short-term role with a duration of up to 6 months. The Medicare Member Services Representative is responsible for being a devoted and compassionate advocate for Medi-Cal, Medi-Medi and Medicare Members when assisting with maximizing their benefits, navigating the healthcare system and reaching their optimal health. Using multiple complex systems, the representative will provide guidance and answer questions from Members about their benefits and medical claims, as well as educate Members about wellness programs. They will assist Members in assessing tools available to help guide decision-making about complex matters related to their wellbeing. The role also facilitates the Members selection and access to in-network healthcare providers and collaborates with inter-departments to ensure Member needs are met. The IEHP Team is committed to incorporating IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. This position is not eligible for benefits. While there is a possibility that this role could lead to a permanent position, permanent employment is not guaranteed and will depend on business needs, performance, and other factors.

Requirements

Internal Candidates: A minimum of twelve (12) months experience as an IEHP Member Services Representative required or two (2) years of experience in a medical setting.
External Candidates: Two (2) years of HMO or Manage Care customer service experience analyzing and solving customer problems
High School Diploma or GED required
Proficiency in Microsoft Office Suite; high level capacity to multitask
Excellent multi-tasking skills
Typing 35 words per minute, proficient in Windows applications, and experience in data entry
Knowledgeable of with the following programs: Cisco Finesse, Verint, HSP, Microsoft
Excellent written and verbal communication and interpersonal skills
Strong organizational skills
Ability and willingness to learn and follow direction in a fast-paced call center environment
Ability and desire to handle 25-30 calls per day. Adherence to specific work schedule is required
Works well in a fast-paced environment
Team culture a must
Positive Attitude and ability to work in a team setting
High level of patience
Telephone courtesy
Attention to detail
Willingness and ability to learn
Ability to work independently within specified time constraints
Excellent punctuality and attendance required
Ability to adapt and perform duties efficiently when unexpected changes arise
This position will work non-traditional hours to achieve coverage during periods where training or extended call center operations are required

Nice To Haves

Knowledge of Medicare managed care is preferred
This is a non-bilingual: bilingual highly preferred position. Identified bilingual team members in this role must take a language proficiency assessment and must receive a passing score.

Responsibilities

Handle Medi-Cal and Medicare Inbound Calls
Responsible for covering the Cisco ACD Queue telephone lines.
Meet IEHP and Member Services Call Center standard and policy requirements.
Assist Members with many different process or benefit information such as: Members eligibility status, Primary care/facility assignments, selections, and changes, Health program education
Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
Maintain knowledge of other department’s roles as they pertain to Member Services standard work processes, to ensure proper handling of calls.
Ensure key performance indicator goals are met monthly (Quality Assurance, AHT, Adherence).
Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.
Off phone work including QA Review, One on One, Projects, Meetings, and any other duties as required to ensure Health Plan operations are successful.
Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.