The Member Service Representative (MSR) II is commonly the initial contact point for members, providers, and others. The MSR II is responsible for answering incoming contacts and assisting them in resolving issues and/or questions they may have. This may involve interaction with other internal departments or external entities such as Medical Groups, Health Care Providers, and/or Brokers. In addition, the MSR II is responsible for resolving issues and/or concerns regarding health plan benefits, policies, and procedures, and assists the Senior MSRs when needed.

Details:

On-site , Natomas, CA

M-F 8am - 5pm

$22 - 25/hr

Representative Duties:

• Respond to all member inquiries related to Commercial, Exchange, and/or Individual plans via telephone, email, chat, or fax.
• Support other Member Service Representatives by answering questions/clarifications regarding plan rules/policies, benefits, and/or system information.
• Research and resolve cases that require additional investigation, including those involving urgent access to care or the Member Relations Unit when necessary.
• Provide training and call shadowing for new MSRs.
• Accurately record and refer appeals and grievances according to department protocols and procedures.
• Educate members on the referral program, website, and available self-service tools.
• Assist members, providers, brokers, and plan partners with claims-related billing questions and issues as needed.
• Work with inter- and intra-department staff to help resolve member issues within prescribed timeframes.
• Meet department standards related to performance and attendance.
• Manage difficult or emotional customer situations; respond promptly to customer needs; solicit feedback to improve service; and ensure commitments are met.
• Report any system problems or call drivers needing immediate attention to the Member Service Supervisor or Manager.
• Use tact, discretion, and courtesy while interacting with clients, the public, and others in the course of work.
• Perform other duties and special projects as assigned.

Qualifications:

• High School Diploma.
• 2 years' experience working in a call center.
• Previous experience in the healthcare industry, specifically HMO, is a plus.
• Basic computer skills, including email, databases, word processing, spreadsheets, and graphics.
• Ability to speak, read, write, and understand the primary language(s) used in the workplace.