Member services Representative

Employment Type

: Full-Time


: Miscellaneous

SUMMARY Under general supervision, following established procedures, assist and direct patients in an empathetic and caring manner, efficiently and timely, and completes appropriate documentation. Responds to provider inquiries and attempts to resolve provider concerns or refers to management for resolution. ESSENTIAL DUTIES AND RESPONSIBILITIES * Call Intake Responsibilities: i. Answer all daily telephone calls from members, providers, health plans, insurance brokers, collection agents and hospitals ii. Elicit information from members/providers including the problem or concerns and provide general status information iii. Verify authorization, claims, eligibility, status only * All calls carefully documented into Company's customer service module & NMM Queue system. * Member/Provider Service/Representative assists Supervisor and Manager with other duties as assigned * Member outreach communications via mail or telephone * Assist Member appointment with providers * Resolve walk-in member concerns * Able to provide quality service to the customers * Able to communicate effectively with customers in a professional and respectful manner * Maintain strictest confidentiality at all times * Specialist termination notifications sent to members * Urgent Medicare Authorization Approval - Notification to Medicare members * Transportation arrangement for Medicare & Medi-Cal members * Outreach Project Assignments * All other duties as assigned QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE High school diploma or general education degree (GED); and one year related experience and/or training; or equivalent combination of education and experience. LANGUAGE SKILLS Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Bilingual Mandarin/Cantonese or Spanish.

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