Member Services Representatives - Medicare (Short-Term)

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OtherMember Services Representative

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Quick Summary

Key Responsibilities

The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. This is a short-term role with a duration of up to 6 months.

Requirements Summary

Members eligibility status Primary care/facility assignments, selections,

Technical Tools

OtherMember Services Representative

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

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, responsible for providing guidance and answering questions from Members about their benefits and medical claims, as well as educating Members about wellness programs. Assisting Members in assessing tools available to help guide decision-making about complex matters related to their wellbeing. Facilitate the Members selection and access to in-network healthcare providers. Collaborate with inter-departments to ensure Member needs are met.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

What We Offer

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IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance

Responsibilities

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→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

→QA Review
→One on One
→Projects
→Meetings

→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.

Requirements

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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
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.

Knowledge of Medicare managed care is preferred
Knowledge of Medical terminology, and Medi-Cal managed care is required
Understanding of and sensitivity to multi-cultural community.
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

This role will transition to telecommuting after training has been successfully completed and upon leader approval. Training will be conducted onsite, five days per week.

USD $23.00 - USD $23.00 /Hr.