Member Services Representatives - Medicare (Short-Term)

Inland Empire Health Plan•Rancho Cucamonga, CA

9d•$23 - $23•Hybrid

About The Position

This is a short-term role (up to 6 months) where you will serve as a devoted and compassionate advocate for Medi-Cal, Medi-Medi, and Medicare Members. Your responsibilities will include assisting them with maximizing their benefits, navigating the healthcare system, and reaching their optimal health. You will use multiple complex systems to provide guidance, answer questions about benefits and medical claims, and educate Members about wellness programs. You will also assist Members in assessing tools to guide decision-making about complex matters related to their wellbeing and facilitate their selection and access to in-network healthcare providers. Collaboration with inter-departments is essential to ensure Member needs are met. A commitment to IEHP's Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation, is expected. This position is not eligible for benefits and while there is a possibility of transitioning to a permanent role, it is not guaranteed.

Requirements

Internal Candidates: A minimum of twelve (12) months experience as an IEHP Member Services Representative required
May substitute with 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
Experience in data entry
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
Bilingual highly preferred
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
Cover the Cisco ACD Queue telephone lines
Meet IEHP and Member Services Call Center standard and policy requirements
Assist Members with process or benefit information such as eligibility status, primary care/facility assignments, selections, and changes, and health program education
Ensure 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
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
Perform off-phone work including QA Review, One on One, Projects, and Meetings
Perform any other duties as required to ensure Health Plan operations are successful