A-Line Staffing is now hiring Member Services Representative in Alameda, CA. The Member Services Representative would be working for a Fortune 500 company and has career growth potential. This would be full time / 40+ hours per week.

If you are interested in this Member Services Representative position, please contact Brady Czape at bczape@alinestaffing.com or 586-519-9767

Member Services Representative Compensation

• The pay for this position is $22-$28/hr
• Benefits are available to full-time employees after 90 days of employment
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates

Member Services Representative Highlights

• This position is a contract assignment with potential to hire on permanently based upon attendance, performance, and business needs
• The required availability for this position is: M-F

Member Services Representative Responsibilities

• Serve as the primary contact for members, providers and others for questions related to claims, benefits, authorizations, pharmacy, member eligibility and other questions.

• Respond to and resolve member service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, behavioral health, and care coordination.
• Answer incoming calls, emails, chats, and other requests for assistance in a timely manner in accordance with departmental performance targets and provide excellent customer service while doing so. May include assisting members in person.
• Recognize and understand the difference between calls that require quick resolutions and calls which will require follow-up and handle each appropriately.
• De-escalate situations involving dissatisfied customers, offering patient assistance and support.
• Accurately document all contacts per department standards/guidelines in the Customer Relationship Management (CRM) system.
• Accurately and consistently document (electronic database) and resolve Exempt Grievances (any expression of dissatisfaction that are not coverage disputes, disputed health care services involving medical necessity, or experimental or investigational treatment and that are resolved by the next business day following receipt).
• Interface with Grievance and Appeals, Claims, Enrollment, IT, Network Management, Pharmacy, Authorizations, and other internal departments to provide Service Excellence to our members.
• Help guide and educate members about the fundamentals and benefits of managed health care topics, to include managing their health and well-being by selecting the best benefit plan service options, maximizing the value of their health plan benefits, and choosing a quality care provider.
• Intercede with care providers (doctor’s offices) on behalf of the member, assisting with appointment scheduling; connect members with internal Case Management Department for assistance as needed.
• Assist members in navigating the Member Portal, and other health care partner online resources and websites to encourage/reassure them to use self- service tools that are available.
• Manage any issues through to resolution on behalf of the member, either on a single call or through comprehensive and timely follow-up.
• Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues.
• Provide education and status on previously submitted pre-authorizations or pre- determination requests for both medical and pharmaceutical benefits.
• Meet the performance goals established for the position in the areas of compliance, efficiency, call quality, member satisfaction, first call resolution, punctuality, and attendance.
• Always maintain a professional level of service to members.
• Always maintain confidentiality of information.

Member Services Representative Requirements

• High School Diploma or GED
• Attendance is mandatory for the first 90 days
• Bilingual (Mandarin, Vietnamese or Cantonese, Spanish) + English
• Prior experience in a call center/conflict resolution type role

Member Services Representative Preferred Qualifications

• Bachelors Degree or equivalent experience
• Medical terminology knowledge

If you think this Member Services Representative position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting!