Title: Member Service Representative
Location: Fountain Valley, CA
Department: Hospital Administration
Status: Full-Time
Shift: Days (8hr)
Pay Range*: $21.25/hr - $29.20/hr
MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.
Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.
Position Summary
The Member Service Representative is the face of MemorialCare Select Health Plan and directly impacts the member service experience by how well customer service inquiries and problems via telephone, internet or written correspondences are handled. The MSR always maintains a positive caller experience.
Essential Functions and Responsibilities of the Job
Documents and tracks contact with members, providers and plan sponsors; ensuring calls and rework are distributed to the appropriate staff. Guides the member through their member plan of benefits, MCSHP policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines. Creates an emotional connection with our members by understanding and engaging the member to the fullest to advocate for our members best health. Takes accountability to fully understand the members needs by building a trusting and caring relationship with the member. Anticipates members needs and provides the customer with related information to answer unasked questions (e.g., additional plan details, benefit plan details, member self-service tools, etc.). Explains members rights and responsibilities in accordance with the contract and regulatory requirements. Supports all Member and Provider Services phone queues as required (Medical Management, Claims, Provider Services). Processes member grievances and appeals received by telephone, fax, email, and through MemorialCare Selects member portal. Meets or exceeds productivity and quality standards as assigned by management. Takes responsibility for various projects as assigned by management and performs any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability. Works as a team player and communicates in a positive manner with co-workers, managers, providers, and other contacts. Maintains patient confidentiality at all times. Educates providers on MCSHPs self-service options. Responds to subpoena requests for medical and claims records. Handles incoming requests for appeals and pre-authorizations not handled by Medical Management. Performs review of member claim history to ensure accurate tracking of benefit maximum and/or coinsurance/deductible. Uses applicable systems tools and resources to produce quality responses to inquiries received. Ability to be at work and be on time. Ability to follow company policies, procedures, and directives. Ability to interact in a positive and constructive manner. Ability to prioritize and multitask. *Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCarethat includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. Check out ourMemorialCare Benefits for more information about our Benefits and Rewards.
Minimum Requirements
Qualifications/Work Experience:
- Minimum of two years experience in a transaction-based environment such as a call center or similar environment.
- Experience in a managed healthcare environment, preferred.
- Basic computer skills, including general knowledge of MS Word and Excel applications; type a minimum of 45 WPM.
- Bi-lingual (Spanish/English) preferred.
Education/Licensure/Certification:
- High school graduate or equivalent, required.
- Bachelors degree, preferred.
- Specialty coding certification required.
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