Member Services Representative - Medi-Cal

What you can expect!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!Exciting advocate for members as a Member service Representatives, guiding them to maximize benefits and navigate the healthcare system. Provide superior service, assisting with benefit inquiries, claims, and wellness programs. Collaborate with inter-departments to meet members needs. Your role includes coordinating translation for non-English/Spanish speakers, efficient problem-solving, and meeting key performance indicators.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.PerksIEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.CalPERS retirement457(b) option with a contribution matchGenerous paid time off- vacation, holidays, sickState of the art fitness center on-siteMedical Insurance with Dental and VisionPaid life insurance for employees with additional optionsShort-term, and long-term disability optionsPet care insuranceFlexible Spending Account - Health Care/ChildcareWellness programs that promote a healthy work-life balanceCareer advancement opportunities and professional developmentCompetitive salary with annual merit increaseTeam bonus opportunitiesProvide Members with health plan education in regard to and Medi-Cal benefit coverage, including understanding coordination of benefits and eligibility rules.Meet IEHP and Member Services Call Center standard and policy requirements. This includes but is not limited to the following: successful completion of Member Services Training, active participation in continuous training, use telephone system and other IEHP equipment appropriately and for professional reasons only, follow required call scripts and adhere to Attendance/Punctuality and Dress Code policy.Provide superior service that delights caller in all aspects of the interaction including:Strive to assist caller on the first point of contact. Demonstrate a high level of patience and respect; avoid distractions to ensure each caller is assisted promptly and appropriately; follow call handle standards and objectives.Assist with Member primary care/facility assignments, selections, and changes; health care options liaison; health education advisory; supply eligibility status of Members to providersMember education including tagging, material request, programs, ordering ID cards and accessing services.When necessary present cases to Member Services Management Team and work with other departments to resolve Member and/or Provider inquiries and/or issues. Including but not limited to transportation requests, interpreter requests, referrals questions/concerns, re-directions, Behavioral Health, and Pharmacy inquiries.Document accurately while speaking with the caller. Complete Member Satisfaction Surveys and Assessments, as needed. Over 100% call documentation is requiredProper and timely intake of Member grievancesCoordinate telephonic translation of calls when Members do not speak English or Spanish.Efficient problem solving, time management, initiative, and focus skills requiring minimum supervision and guidance.High technological aptitude with efficient adaptability to diverse and changing systems and business conditions.Ensure key performance indicator goals are met monthly.Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance. Demonstrate a commitment to understand and adhere to the Regulatory requirements as they relate to the business unit.Preserve Member’s confidentiality by authenticating callers (submitting guardianship documents for verification, establish guardianship alerts, authentication passwords and confidentiality alerts as needed).Demonstrate a commitment to LEAN by participating in process improvement projects and RIE Events/Huddles. Act as an owner and submit ideas on efficiency gains.Assist Members with navigating self-service options.Assist with tracking trends within the department and escalating this information to management.Review call monitors recordings and develop self-action plans to improve quality assurance scores.Maintain knowledge of other departments and the roles they play in Member Services standard work processes, to ensure proper handling and tasking of calls.Comply with IEHP Telecommuting Agreement and requirements, as applicable.Education & RequirementsOne (1) year of Customer Service experience analyzing and solving customer problemsHigh school diploma or GED requiredThis is a non-bilingual: bilingual preferred position. Identified bilingual team members in this role must take a language proficiency assessment and must receive a passing score.Key QualificationsHMO or Managed Care Experience preferredOne (1) year call center experience in a customer service setting preferredMedi-Cal program and benefit requirements experience preferredProficiency in Microsoft Office Suite and Windows based programsTyping Minimum 35 wpm, good grammar and spelling skills are necessaryExcellent oral communication skillsStart your journey towards a thriving future with IEHP and apply TODAY!Telecommute, with onsite training.USD $23.00 - USD $23.00 /Hr.

Created: 2025-11-17