Member Services Representative

Job DescriptionJob Description

Responsible for assisting members with questions regarding authorizations and providers. Representatives will also be responsible for logging calls to summarize the issue, follow up and resolution.

Duties and Responsibilities

1. Answer inbound calls from members and assists them with questions regarding authorizations, provider selection and other issues.

2. Learns IPA business rules and assists with basic authorization set up.

3. Actively performs transactions in response to member requests and displays professional telephone etiquette.

4. Work with specialists, PCPs and ancillary providers to assist with scheduling members for above services when necessary.

5. Consistently meets deadlines and service level requirements for hold time and call volume.

6. Demonstrates ability to use the computer to perform job functions.

7. Asks for assistance, when necessary, to handle more complex issues.

8. Displays flexibility to perform administrative and non-telecommunication duties as needed.

9. Actively participates in self-development programs.

Minimum Job Requirements

· High School graduate or GED equivalent

· One year working in a call center environment; health care environment preferred

· Ability to work varying shifts if requested to assist in increasing patient outreach

Skill and Abilities

· Effective verbal and written communication skills and effective interpersonal skills

· Ability to work well in a busy environment

· Able to stay focused on the telephone even with noise and other distractions

· Bilingual (Spanish and English) preferred

· Minimum or higher proficiency level with Microsoft Office programs; primarily Word and Excel 2013 or higher

· EZ-CAP knowledge a plus

Location: Los Angeles, CA, US

Posted Date: 11/1/2024